Sverre Elise, Otterstad Jan Erik, Gjertsen Erik, Gullestad Lars, Husebye Einar, Dammen Toril, Moum Torbjørn, Munkhaugen John
Department of Medicine, Drammen Hospital, PB 800, 3004, Drammen, Norway.
Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway.
BMC Cardiovasc Disord. 2017 Sep 6;17(1):241. doi: 10.1186/s12872-017-0676-1.
Understanding the determinants of persistent smoking after a coronary event constitutes the basis of modelling interventions of smoking cessation in secondary prevention programs. We aim to identify the potentially modifiable medical, sociodemographic and psychosocial factors, comprising the study factors, associated with unfavourable risk factor control after CHD events.
A cross-sectional explorative study used logistic regression analysis to investigate the association between study factors and smoking status in 1083 patients hospitalized with myocardial infarction and/or coronary revascularization. Hospital record data, a self-report questionnaire, clinical examination and blood samples were applied.
At the index hospitalization, 390 patients were smoking and at follow-up after 2-36 months 167 (43%) of these had quit, while 230 reported persistent smoking. In adjusted analyses, unemployed or disability benefits (Odds ratio (OR) 4.1), low education (OR 3.5), longer smoking duration (OR 2.3) and not having ST-elevation myocardial infarction (STEMI) as index event (OR 2.3) were significantly associated with persistent smoking. Psychosocial factors at follow-up were not associated with persistent smoking. Smokers reported high motivation for cessation, with 68% wanting help to quit. Only 42% had been offered nicotine replacement therapy or other cessation aids. Smokers rated use of tobacco as the most important cause of their coronary disease (6.8 on a 1-10 Likert scale).
Low socioeconomic status, prior duration of smoking, and not having STEMI as index event were associated with persisting smoking. Persistent smokers in this study seem to have an acceptable risk perception and were motivated to cease smoking, but needed assistance through cessation programs including prescription of pharmacological aids.
Registered at ClinicalTrials.gov: NCT02309255 , registered retrospectively.
了解冠心病事件后持续吸烟的决定因素是制定二级预防计划中戒烟干预措施的基础。我们旨在确定与冠心病事件后不良危险因素控制相关的潜在可改变的医学、社会人口学和心理社会因素，即研究因素。
一项横断面探索性研究采用逻辑回归分析，调查了1083例因心肌梗死和/或冠状动脉血运重建住院患者的研究因素与吸烟状况之间的关联。使用了医院记录数据、自我报告问卷、临床检查和血液样本。
在首次住院时，390例患者吸烟，在2至36个月的随访中，其中167例（43%）已戒烟，而230例报告仍在持续吸烟。在调整分析中，失业或领取残疾津贴（比值比（OR）4.1）、低教育水平（OR 3.5）、吸烟时间较长（OR 2.3）以及非ST段抬高型心肌梗死（STEMI）作为首发事件（OR 2.3）与持续吸烟显著相关。随访时的心理社会因素与持续吸烟无关。吸烟者报告戒烟动机较高，68%的人希望获得戒烟帮助。只有42%的人接受过尼古丁替代疗法或其他戒烟辅助手段。吸烟者将吸烟评为其冠心病最重要的病因（1至10李克特量表评分为6.8）。
社会经济地位低、既往吸烟时间以及非STEMI作为首发事件与持续吸烟有关。本研究中的持续吸烟者似乎有可接受的风险认知，并有戒烟动机，但需要通过包括药物辅助处方在内的戒烟计划获得帮助。
在ClinicalTrials.gov注册：NCT02309255，回顾性注册。
