Prevention

Encourage patients to stop smoking ^a and ask nurses ^a and other staff ^a to provide further advice. 

Why?

• Patients who continue to smoke are at increased risk of dying or having another myocardial infarction. ^a

Patients who keep smoking are at increased risk of dying or reinfarcting.

Patient	Prognostic Factor	Outcome	CER	RR (95% CI)	NNF+ (95% CI)
myocardial infarction a	continuing to smoke independent	death at 10 years	23% (20% to 25%)	1.60 (1.26 to 2.02)	9 (6 to 21)
		non-fatal MI at 10 years	24% (21% to 26%)	1.50 (1.20 to 1.88)	10 (6 to 27)

• Patients who receive advice from doctors are more likely to stop ^a and from nurses are more likely to stay off cigarettes. ^a
• A nurse-run smoking cessation program is cost-effective. ^a

Physician advice helps patients with a myocardial infarction stop smoking

Patient	Treatment	Comparison	Outcome	ARR (95% CI)	NNT (95% CI)
myocardial infarction a	physician advice	no advice	stopped smoking at months	36% (23% to 48%)	3 (2 to 4)

Advice from doctors and nurses helps smokers stop cigarettes long-term

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
smoker a	brief advice from physicians	no advice	sustained smoking cessation at 6 months	4.1%	1.69 (1.45 to 1.98)	38 (27 to 57)
adult smoker a	nursing advice	no advice	sustained smoking cessation at ?months	13%	1.43 (1.24 to 1.66)	22 (15 to 39)

• Two-thirds of men with a myocardial infarction who receive repeated advice to stop smoking will quit (63%: 95% CI: 55% to 72%). A sixth will continue smoking at the same rate (15%: 95% CI: 8.9% to 22%). ^a
• Brief verbal advice and a booklet is as effective as a more detailed 30 minute intervention for patients with a myocardial infarction.. ^a