University of Iowa Carver College of Medicine and Iowa City VA Hospital, Iowa City, IA 52246-2208, USA.
Am Heart J. 2011 Jul;162(1):74-80. doi: 10.1016/j.ahj.2011.03.010.
Although current performance measures recommend smoking cessation counseling at the time of acute myocardial infarction (AMI), the American College of Cardiology/American Heart Association guidelines recommend pharmacotherapy as well. The aim of this study was to describe the prevalence and correlates of smoking cessation pharmacotherapy in hospitalized patients with AMI.
In the 24-center TRIUMPH registry, 4,340 AMI patients underwent detailed interviews; and 1,631 reported smoking within 30 days of admission. Prescription of first-line smoking cessation medications at discharge was assessed by medical record review. All patient-related factors associated with smoking cessation treatment, based on literature review, were included in hierarchical modified log Poisson models.
Only 14% (222/1,631) of AMI patients who smoked were prescribed smoking cessation medication at discharge. After multivariable adjustment for patient characteristics, there was significant variation across sites (range 0%-28%, median rate ratio 1.41, 95% CI 1.23-2.67). Independent factors associated with smoking cessation pharmacotherapy included older age (rate ratio 0.81 per 10-year increment, 95% CI 0.71-0.93), high school graduation (rate ratio 1.37, 95% CI 1.10-1.66), heavy cigarette usage (>20/d) (rate ratio 3.08, 95% CI 2.20-4.12), in-hospital revascularization (rate ratio 1.41, 95% CI 1.0-1.94), and instructions on smoking cessation (rate ratio 2.37, 95% CI 1.40-4.01).
Smokers surviving an AMI are infrequently prescribed guideline-recommended smoking cessation treatments, and there is considerable variation across hospitals. Older, less educated, and lighter smokers are less likely to receive aggressive smoking cessation treatment. Novel strategies to augment current practice are needed.
尽管目前的绩效评估建议在急性心肌梗死（AMI）发作时进行戒烟咨询，但美国心脏病学会/美国心脏协会指南也建议使用药物治疗。本研究旨在描述住院 AMI 患者戒烟药物治疗的流行情况和相关因素。
在 24 个中心的 TRIUMPH 注册研究中，对 4340 名 AMI 患者进行了详细的访谈；其中 1631 名患者在入院后 30 天内报告吸烟。通过病历回顾评估出院时开具一线戒烟药物的情况。根据文献综述，将所有与患者相关的、与戒烟治疗相关的因素纳入分层修正泊松回归模型。
在吸烟的 AMI 患者中，仅有 14%（222/1631）在出院时开具了戒烟药物。对患者特征进行多变量调整后，各中心之间仍存在显著差异（范围 0%-28%，中位数率比 1.41，95%置信区间 1.23-2.67）。与戒烟药物治疗相关的独立因素包括年龄较大（每增加 10 岁，率比为 0.81，95%置信区间为 0.71-0.93）、高中毕业（率比为 1.37，95%置信区间为 1.10-1.66）、重度吸烟（>20 支/天）（率比为 3.08，95%置信区间为 2.20-4.12）、住院血管重建术（率比为 1.41，95%置信区间为 1.0-1.94）和戒烟指导（率比为 2.37，95%置信区间为 1.40-4.01）。
幸存的 AMI 吸烟者很少接受指南推荐的戒烟治疗，且各医院之间存在较大差异。年龄较大、受教育程度较低和吸烟较轻的患者接受强化戒烟治疗的可能性较低。需要采取新的策略来加强当前的实践。
