Cardiologist have a ‘critical’ role in helping patients quit

Cardiologists shouldn’t shy away from discussing smoking cessation strategies with their ACS patients says an expert following research that finds quitting has a massive impact on survival rates.

The study revealed that patients who continued to smoke after an ACS had an almost twofold risk of lower survival compared to non smokers while those who quit have a survival rate that is comparable to a non smoker in just four years.

The observational study published in BMJ Open also revealed that only about half of patients who smoke quit the deadly habit in the month after being discharged from hospital. Yet almost a quarter of these patients relapse one year later.

The research from the Melbourne Interventional Group (MIG) is the first Australian data to report on the impact of smoking cessation on ACS in patients treated with PCI and optimal secondary prevention pharmacotherapy.

Speaking to the limbic, Professor Chris Reid a cardiovascular epidemiologist and the principal investigator for the MIG said even despite this optimal management the mortality risk for persistent smokers remains virtually unchanged from earlier studies that pre date the PCI era.

 He said implementation of smoking cessation strategies is ‘crucial’ adding that the index hospitalisation is the perfect opportunity.

“For many people who have an acute cardiovascular event it can be a life changing experience and this is an opportunity to look at factors that contribute to the event …it’s a very, very important opportunity to raise the prospect of smoking cessation and the best strategy to achieve it,” he stressed.

While it’s not considered part of the armoury of conventional post PCI or ACS treatment Professor Reid said cardiologists should talk to patients who are persistent smokers about smoking cessation drugs.

“Certainly, in the consultation if it’s deemed appropriate and the patients are willing then there’s no doubt that cardiologists should prescribe them,” he told the limbic.

He also noted that the severity of ACS presentation might be a strong trigger to quit, as patients in the study presenting with STEMI were more likely to quit compared to patients presenting with NSTEMI or unstable angina.

Encouragingly for the cohort of quitters, their mortality rate approached that of life-long non-smokers within just four years.

Professor Reid and colleagues gathered patient data from the Melbourne Interventional Group registry, which is Australia’s largest PCI outcomes registry.

They focused on some 9375 patients who were admitted for ACS between 2005 and 2013, of whom about 31% were current or recent smokers.

Smokers were younger and had lower rates of diabetes, hypertension and hypercholesterolaemia than non-smokers, which Professor Reid said highlights the significant role of smoking in the pathogenesis of ACS.

“We now have this very good data that shows the clear benefits in terms of smoking cessation – even those who recently quit close to their PCI had a better survival outcome than those who continued to smoke.

So the role of the cardiologist in helping patients stop smoking is critical – it’s probably one of the best things they can do in terms of an intervention and that’s to encourage people to stop smoking.”

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