Abstract 15477: Outpatient Cardiac Rehabilitation and Smoking Cessation in Patients with Acute Myocardial Infarction

Abstract

Background: Smoking cessation is a cost-effective intervention known to reduce the risk of mortality and recurrent cardiac events in patients with acute myocardial infarction (AMI). Outpatient cardiac rehabilitation (OCR) provides reinforcement for patients in their efforts to quit smoking, but the relationship between actual participation in OCR and smoking status post-AMI is uncharacterized.

Methods: We conducted a prospective study of hospitalized smokers with confirmed AMI who registered in either the PREMIER or TRIUMPH studies. All patients who smoked at least 1 cigarette per month at baseline and completed 1, 6, and 12-month follow-up were eligible (n=996). Structured interviews were completed on all subjects. Any participation in OCR was self-reported at 1 or 6 month follow-up. Smoking status was ascertained by a standardized question defining any smoking within the prior 30 days (30-day point prevalence abstinence, PPA). As patients who participate in OCR may differ from those who do not, we constructed a propensity model of OCR participation based on 19 baseline sociodemographic and clinical characteristics. Hierarchical modified Poisson regression models of 30-day PPA at 1 and 12 months were fit, adjusting for the propensity for OCR participation, pre-defined smoking characteristics, psychosocial factors, and visit rates, with clinical site treated as a random effect.

Results: Overall, 71% of subjects were referred to OCR at hospital discharge, and 37% reported participation in OCR during follow-up. At 1 month after discharge, 46% of patients had resumed smoking. At 12-month follow-up, the 30-day PPA was 59% among OCR participants, compared to 41% among OCR non-participants. Self-reported participation in OCR was a significant predictor of 30-day PPA at both 1 month (multivariate-adjusted RR 1.20, 95% CI 1.00-1.44) and 12 months (RR 1.27, 95% CI 1.07-1.51).

Significance: Only about half of smokers referred to OCR reported any participation. Those who did participate were significantly more likely to abstain from smoking 12 months after AMI hospitalization. Aggressive efforts to encourage smokers to participate in OCR are warranted.