Inpatient smoking cessation counseling is associated with early differences in mortality

Giving up smoking after a heart attack has been clearly associated with improvements in long-term patient survival, but how soon after myocardial infarction does smoking cessation begin to have positive effects? A study published in the current issue of The American Journal of Medicine indicates in-hospital cessation counseling following heart attacks is associated with better short-term survival. Counseling smokers to quit reduced their chances of dying in the first 30 days, 60 days and up to 1 year after their attacks.

The study, conducted by investigators at the University of Alabama at Birmingham and the Deep South Center on Effectiveness at the Birmingham VA Medical Center, Birmingham, Alabama, analyzed the patient records of over 16,000 smokers, finding that 41% had received counseling. Compared with those not counseled, those who had received inpatient counseling had lower 30-day (2.0% vs. 3.0%), 60-day (3.7% vs. 5.6%), and 2-year mortality (25.0% vs. 30%). Even after adjusting for other factors such as demographic characteristics and comorbid conditions, those counseled were still less likely to die in the first year.

Writing in the article, Thomas K. Houston, MD, MPH, explains, “The positive association of smoking cessation counseling with survival that we observed provides evidence for an association suggested, but not directly demonstrated, by previous reports on the impact of counseling on cessation and the impact of cessation on mortality. In addition, the association of counseling with mortality was seen early, within 30 days. A major conclusion of the U.S. Surgeon General’s report Health Effects of Smoking Cessation is that quitting smoking has an immediate effect on mortality. However, the ’immediate’ effect referred to is the reduction in mortality over the first year of cessation. Our research suggests an even more immediate positive association within 30 days of quitting after a cardiac event. Because we observed much of the overall difference in mortality by smoking cessation counseling early, an alternative strategy for risk reduction in those patients unwilling to quit for good would be to recommend, at a minimum, to maintain the in-hospital mandated smoking deprivation for a brief period after discharge.”

Many states are already beginning to pay for anti-smoking counseling. The Centers for Disease Control encourage physician intervention to encourage patients to give up smoking. This study will add strong support to those efforts.

The study is reported in “Post-myocardial Infarction Smoking Cessation Counseling: Associations with Immediate and Late Mortality in Older Medicare Patients” by Thomas K. Houston, MD, MPH, Jeroan J. Allison, MD, Sharina Person, PhD, Stacey Kovac, PhD, O. Dale Williams, PhD, and Catarina I. Kiefe, PhD, MD. The article appears in The American Journal of Medicine, Volume 118, Number 3 (March 2005), published by Elsevier.