Abstract
Background
Although smoking cessation is essential to the management of acute myocardial infarction
(AMI), prevalence and benefits of smoking-cessation counseling in the inpatient setting
are not well described among older adults. The objective of this study was to evaluate
associations between inpatient smoking-cessation counseling and 5-year all-cause mortality
among older adults hospitalized with AMI.
Methods
The Cooperative Cardiovascular Project (January 1994–July 1995) included 788 Medicare
beneficiaries aged ≥65 years who were current smokers, admitted to acute care facilities
in North Carolina with confirmed AMI, and discharged alive. Information on smoking-cessation
advice or counseling prior to discharge was abstracted from medical records. Associations
of counseling with 5-year risk of death were assessed with multivariate Cox proportional
hazards regression.
Results
Smoking-cessation counseling was provided to 40% of AMI patients before discharge.
Women (p =0.06) and blacks (p =0.02) were less likely to receive counseling. Counseling was associated with a history
of chronic obstructive pulmonary disease (p =0.01). Increasing age, discharge to a skilled nursing facility, and histories of
hypertension, heart failure, or stroke were associated with no counseling (p <0.05, all cause). Age-adjusted mortality rates (per 1000 enrollees) at 5 years were
488.3 for patients who were given counseling compared to 579.3 for patients without
counseling. After adjustment for age, race, gender, prior histories of hypertension,
cardiovascular diseases, diabetes, and chronic obstructive pulmonary disease, Killip
class III or IV, and discharge to a skilled nursing facility; inpatient counseling
remained associated with improved survival (relative hazard, 0.78; 95% confidence
interval, 0.63–0.97).
Conclusions
Inpatient counseling on smoking cessation is suboptimal among older smokers hospitalized
with AMI. Even without confirmation of actual cessation, these data suggest that provision
of smoking-cessation advice or counseling has a major impact on survival of older
adults.
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Article Info
Footnotes
☆Address reprint requests to: Medical Review of North Carolina, P.O. Box 37309, Raleigh NC 27627.
Identification
Copyright
© 2004 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
