Smoking cessation after nurse-coordinated referral to a comprehensive lifestyle programme in patients with coronary artery disease: a substudy of the RESPONSE-2 trial

Abstract

Objective:

The objective of this study was to investigate the characteristics of successful quitters, their use of a smoking cessation programme and the use of other lifestyle interventions to improve lifestyle-related risk factors, within a nurse-coordinated care programme.

Methods:

We used data from the multicentre randomised controlled RESPONSE-2 trial (n=824, The Netherlands). The trial was designed to assess the efficacy of nurse-coordinated referral to a comprehensive set of up to three community-based interventions, based on smoking cessation, healthy food choices and physical activity to improve lifestyle-related risk factors in coronary artery disease patients, compared to usual care. Smoking status was assessed using urinary cotinine at baseline and 12 months follow-up.

Results:

At 12 months follow-up, there was no statistically significant difference in cessation rates (50% intervention group vs. 46% usual care group, P=0.45). The majority of successful quitters in both groups quit immediately after hospitalisation (72% intervention group vs. 86% usual care group, P=0.29). Only 19% of successful quitters in the intervention group participated in the smoking cessation programme. However, successful quitters participated more frequently in other lifestyle programmes compared with persistent smokers (65% vs. 37%, P<0.01).

Conclusion:

The majority of patients who successfully quit smoking are those who quit immediately after hospitalisation, without a need to participate in a smoking cessation programme. Moreover, this programme was attended by only a minority of successful quitters. Successful quitters were motivated to attend other lifestyle programmes addressing healthy food choices and physical activity. Our findings support a tailored, comprehensive approach to lifestyle interventions in the secondary prevention of coronary artery disease.

Keywords

Smoking cessation coronary artery disease lifestyle intervention nurse-coordinated care secondary prevention

Get full access to this article

View all access options for this article.

References

Clark

Hartling

Vandermeer

et al . Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 659–672.

Iestra

Kromhout

van der Schouw

et al . Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation 2005; 112: 924–934.

Smith

Benjamin

Bonow

et al . AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011; 124: 2458–2473.

Piepoli

Hoes

Agewall

et al . 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381.

Chow

Jolly

Rao-Melacini

et al . Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010; 121: 750–758.

Kotseva

De Bacquer

Jennings

et al . Time trends in lifestyle, risk factor control, and use of evidence-based medications in patients with coronary heart disease in Europe: results from 3 EUROASPIRE Surveys, 1999–2013. Global Heart 2016. http://dx.doi.org/10.1016/j.gheart.2015.11.003 (accessed 6 August 2018).

Kotseva

Wood

De Bacquer

et al . EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol 2016; 23: 636–648.

Snaterse

Dobber

Jepma

et al . Effective components of nurse-coordinated care to prevent recurrent coronary events: a systematic review and meta-analysis. Heart 2016; 102: 50–56.

Jorstad

von Birgelen

Alings

et al . Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial. Heart 2013; 99: 1421–1430.

10.

Jennings

Astin

A multidisciplinary approach to prevention. Eur J Prev Cardiol 2017; 24: 77–87.

11.

Allen

Dennison-Himmelfarb

Szanton

et al . Community Outreach and Cardiovascular Health (COACH) Trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. Circ Cardiovasc Qual Outcomes 2011; 4: 595–602.

12.

Minneboo

Lachman

Snaterse

et al . Community-based lifestyle intervention in patients with coronary artery disease: the RESPONSE-2 Trial. J Am Coll Cardiol 2017; 70: 318–327.

13.

Lachman

Minneboo

Snaterse

et al . Community-based comprehensive lifestyle programs in patients with coronary artery disease: objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2). Am Heart J 2015; 170: 216–222.

14.

Trimbos. Netherlands Institute of Mental Health and Addiction. Update guideline treatment of tobacco dependence and smoking cessation. Utrecht: Trimbos Institute, 2017.

15.

Snaterse

Scholte

Reimer

Dobber

et al . Smoking cessation after an acute coronary syndrome: immediate quitters are successful quitters. Neth Heart J 2015; 23: 600–607.

16.

Ussher

Taylor

Faulkner

Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2012; 1: CD002295.

17.

Scholte

Reimer

de Swart

De Bacquer

et al . Smoking behaviour in European patients with established coronary heart disease. Eur Heart J 2006; 27: 35–41.

18.

Bem

DJ.

Self-perception: an alternative interpretation of cognitive dissonance phenomena. Psychol Rev 1967; 74: 183–200.

19.

Aubin

Farley

Lycett

et al . Weight gain in smokers after quitting cigarettes: meta-analysis. BMJ 2012; 345: e4439.

20.

Cohen

Assyag

Boyer-Chatenet

et al . An education program for risk factor management after an acute coronary syndrome: a randomized clinical trial. JAMA Intern Med 2014; 174: 40–48.

21.

Ijzelenberg

Hellemans

Tulder

et al . The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial. BMC Cardiovasc Disord 2012; 12: 71.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB