Van Spall Harriette G C, Chong Alice, Tu Jack V
Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
Am Heart J. 2007 Aug;154(2):213-20. doi: 10.1016/j.ahj.2007.04.012.
Smoking cessation is associated with improved health outcomes, but the prevalence, predictors, and mortality benefit of inpatient smoking-cessation counseling after acute myocardial infarction (AMI) have not been described in detail.
The study was a retrospective, cohort analysis of a population-based clinical AMI database involving 9041 inpatients discharged from 83 hospital corporations in Ontario, Canada. The prevalence and predictors of inpatient smoking-cessation counseling were determined. Associations were drawn between counseling and all-cause 1-year mortality using multivariate Cox proportional hazards regression model and controlling for important validated predictors of post-MI mortality.
A majority of patients with AMI (67.4%) had a history of smoking and 39.0% were current smokers. Current smokers presented with AMI at a much younger average age than former- and never-smokers (mean [+/-SD] ages 59.0 +/- 12.5, 68.9 +/- 11.4, and 70.6 +/- 12.8 years, respectively). Only 52.1% of current smokers were offered smoking-cessation counseling. Multivariate predictors of counseling included a history of asthma (odds ratio [OR] 1.62, 95% CI 1.15-2.31) and admission to a large hospital (OR 1.74, 95% CI 1.37-2.22). Factors associated with no counseling included increasing patient age (OR 0.69, 95% CI 0.65-0.74), a history of diabetes (OR 0.77, 95% CI 0.63-0.93), and admission under the care of a cardiologist (OR 0.67, 95% CI 0.52-0.85) or internist (OR 0.72, 95% CI 0.58-0.88). After adjustment for predictors of post-MI mortality, counseled smokers had a lower risk of mortality (hazard ratio 0.63, 95% CI 0.44-0.90) than those not counseled.
Post-MI inpatient smoking-cessation counseling is an underused intervention, but is independently associated with a significant mortality benefit. Given the minimal cost and potential benefit of inpatient counseling, we recommend that it receive greater emphasis as a routine part of post-MI management.
戒烟与改善健康状况相关，但急性心肌梗死（AMI）后住院戒烟咨询的患病率、预测因素及死亡率获益情况尚未得到详细描述。
本研究是一项基于人群的临床AMI数据库的回顾性队列分析，涉及加拿大安大略省83家医院机构出院的9041名住院患者。确定了住院戒烟咨询的患病率和预测因素。使用多变量Cox比例风险回归模型并控制心肌梗死后死亡率的重要有效预测因素，得出咨询与全因1年死亡率之间的关联。
大多数AMI患者（67.4%）有吸烟史，39.0%为当前吸烟者。当前吸烟者患AMI时的平均年龄比既往吸烟者和从不吸烟者年轻得多（平均年龄[±标准差]分别为59.0±12.5岁、68.9±11.4岁和70.6±12.8岁）。只有52.1%的当前吸烟者接受了戒烟咨询。咨询的多变量预测因素包括哮喘病史（比值比[OR]1.62，95%可信区间1.15 - 2.31）和入住大型医院（OR 1.74，95%可信区间1.37 - 2.22）。与未接受咨询相关的因素包括患者年龄增加（OR 0.69，95%可信区间0.65 - 0.74）、糖尿病病史（OR 0.77，95%可信区间0.63 - 0.93）以及在心脏病专家（OR 0.67，95%可信区间0.52 - 0.85）或内科医生（OR 0.72，95%可信区间0.58 - 0.88）的照料下入院。在对心肌梗死后死亡率的预测因素进行调整后，接受咨询的吸烟者的死亡风险（风险比0.63，95%可信区间0.44 - 0.90）低于未接受咨询的吸烟者。
心肌梗死后住院戒烟咨询是一种未得到充分利用的干预措施，但与显著的死亡率获益独立相关。鉴于住院咨询成本极低且潜在益处大，我们建议将其作为心肌梗死后管理的常规部分予以更多重视。
