Smoking Cessation among Patients with Coronary Heart disease.

Cardiovascular disease is one of the leading causes of death in the Netherlands, and coronary heart diseases have an important share in this. Smoking cessation after development of coronary heart disease improves prognosis more than any other treatment and prevents future cardiovascular diseases. Smoking cessation reduces the risk of reoccurrence of coronary events after one year by 50%. However, 57% of those who smoked prior to a cardiac event persist in smoking or relapse. The study which is running at present has been implemented as there is need for improved intensive and feasible smoking cessation interventions for Dutch cardiac inpatients. After its completion, this study aims to provide hospitalized coronary heart disease patients who smoke with effective smoking cessation interventions. This study is a collaboration with cardiac wards of eight hospitals throughout the Netherlands. By means of an experimental study design with one baseline measurement and two follow-up measurements (after 6 and 12 months), two intensive counselling interventions (personal coaching and telephone coaching, both including nicotine replacement therapy) will be compared to the usual care to explore their (cost-) effectiveness. The feasibility of the interventions (in case of proved effectiveness) in practice will also be studied to detect relevant conditions for large-scale dissemination to the general hospital public.

Smoking cessation after development of coronary heart disease improves prognosis
more than any other treatment and prevents future cardiovascular diseases. This study aims to provide hospitalized coronary heart disease patients who smoke with proven (cost)effective smoking cessation interventions. Point prevalence abstinence is estimated in the experimental groups at 60% at 6 months, against 43% in the control group. After 12 months, 55% abstinence in experimental groups and 35% in the control group are estimated.

1. Baseline measurement while patients are hospitalized at cardiac wards;

2. Follow-up measurements 6 months and 12 months after the baseline measurement.

Total inclusion period is 9 months for every participating hospital.

The interventions consist of intensive counselling by smoking cessation professionals, either by telephone in one intervention and by face-to-face counselling in the other. These comparable interventions differ in delivery mode and
duration. In both interventions, ward nurses start assessing patients’ smoking behaviour followed by providing stop-smoking advice and referral to smoking cessation counselling. In one intervention, we deliver counselling by telephone (TC), in the other face-to-face (FC). During the TC, the patient is called seven times x fifteen minutes. During the FC, the patient has six consultations x 45 minutes with the personal coach and a telephone follow-up call five weeks after the last consultation (fifteen minutes). Both interventions include nicotine replacement therapy and will be compared to the usual care cardiac wards deliver to support cardiac patients to quit smoking.