Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
Swiss Med Wkly. 2022 Jul 18;152:w30209. doi: 10.4414/smw.2022.w30209.
In the Special Program University Medicine-Acute Coronary Syndromes (SPUM-ACS) observational study (clinical trial registration: NCT01000701), a multicentre before-after clinical trial, we assessed 5-year outcome after acute coronary syndrome, comparing a systematic with an opportunistic smoking cessation counselling phase.
We studied smokers who were hospitalised for acute coronary syndromes (ACS), and we assessed self-reported smoking cessation, incidence of cardiovascular events and mortality 5 years after hospital discharge. In the observational phase, from August 2009 to October 2010, only smokers who requested smoking cessation counselling received it during hospitalisation. In the interventional phase, from November 2010 to February 2012, hospitalised smokers with ACS were systematically offered intensive smoking cessation counselling including four telephone calls within 2 months of discharge. Because of the before-after design, the care givers were aware of study phase. The objective was to assess whether systematic counselling to every smoker with ACS has an impact on the long-term smoking cessation rate, incidence of cardiovascular events and mortality. Missing data on smoking cessation were analysed with multiple imputation. The study was not powered to assess differences in 5-year smoking cessation rates or cardiovascular outcomes.
Overall, 458 smokers with ACS were included at baseline (225 during the intervention phase and 233 during the observation phase). At 5 years, 286 (62.4%) reported their smoking status (140 for the intervention phase and 146 for the observation phase) and 51 (11.1%) had died. There was no statistically significant difference in the abstinence rate between the interventional phase (75/140, 54%), and the observational phase (68/146, 47%), with a risk ratio with multiple imputation adjusted for age, sex, education and ACS type of 1.13 (95% confidence interval [CI] 0.84-1.51, p = 0.4). The 5-year risk of major acute cardiovascular event was similar in the intervention phase as compared with the observational phase. The multivariate adjusted hazard ratio for all-cause mortality was 0.84 (95% CI 0.45-1.60, p = 0.6).
In this controlled long-term interventional study, systematic intensive smoking cessation counselling in all hospitalised smokers with ACS did not increase 5-year smoking cessation rates, nor decrease cardiovascular event recurrence, as compared with opportunistic smoking cessation counselling during hospitalization.
在特殊项目大学医学-急性冠状动脉综合征（SPUM-ACS）观察性研究（临床试验注册：NCT01000701）中，我们评估了急性冠状动脉综合征后 5 年的结果，比较了系统与机会性戒烟咨询阶段。
我们研究了因急性冠状动脉综合征（ACS）住院的吸烟者，并评估了他们在出院后 5 年内的自我报告戒烟情况、心血管事件发生率和死亡率。在观察阶段（2009 年 8 月至 2010 年 10 月），仅在住院期间要求戒烟咨询的吸烟者接受了该咨询。在干预阶段（2010 年 11 月至 2012 年 2 月），系统地为住院的 ACS 吸烟者提供强化戒烟咨询，包括出院后 2 个月内的 4 次电话咨询。由于前后设计，护理人员了解研究阶段。目的是评估对每个 ACS 吸烟者进行系统咨询是否会影响长期戒烟率、心血管事件发生率和死亡率。对戒烟的缺失数据进行了多重插补分析。该研究没有足够的能力来评估 5 年戒烟率或心血管结局的差异。
总体而言，共有 458 名 ACS 吸烟者入组（干预阶段 225 例，观察阶段 233 例）。在 5 年内，286 名（干预阶段 140 名，观察阶段 146 名）报告了他们的吸烟状况，51 名（11.1%）死亡。在干预阶段（75/140，54%）和观察阶段（68/146，47%）的戒烟率之间没有统计学上的显著差异，经过年龄、性别、教育程度和 ACS 类型调整的风险比为 1.13（95%置信区间[CI]0.84-1.51，p=0.4）。干预阶段与观察阶段的主要急性心血管事件风险相似。全因死亡率的多变量调整后的危害比为 0.84（95%置信区间[CI]0.45-1.60，p=0.6）。
在这项控制的长期干预研究中，与住院期间的机会性戒烟咨询相比，对所有住院 ACS 吸烟者进行系统的强化戒烟咨询并没有增加 5 年的戒烟率，也没有降低心血管事件的复发率。
