Learning Objectives: Identify the potential utility of hospital-based tobacco intervention for patients admitted with presumptive acute myocardial infarction.
Abstract: PROBLEM: Each year more than 190,000 people die of cardiovascular disease related to tobacco use. Tobacco abstinence greatly improves health outcomes for patients with cardiovascular disease. The potential health impact of tobacco-use interventions in the hospital setting is significant.
METHODS: We implemented a standing order for intensive tobacco-use interventions of all patients with tobacco use in the last 6 months who were admitted to coronary care services at the Mayo Clinic in Rochester, MN, starting on January 1, 2000. The intervention was delivered by nicotine dependence counselors and incorporated behavioral and pharmacologic therapies with reinforcement through telephone follow-up. We performed a chart review to characterize patient demographics and determine outcomes.
RESULTS: Forty patients were admitted for presumptive acute myocardial infarction under the standing order from January 1, 2000, to September 30, 2001. Most patients were male (80%), aged 52 (SD=10) years, and had smoked 50 (SD=24) pack-years. Eighteen percent of patients had a history of a previous myocardial infarction. Telephone follow-up was made with 82% of patients at 7 days and 65% at 6 months. The 7-day, 1-month, 3-month, and 6-month self-reported abstinence rates from all tobacco were 68%, 58%, 53%, and 48%, respectively (N=40). DISCUSSION: These conservative abstinence rates compare with those of highly successful hospital tobacco interventions. This program serves as a model to other hospitals that wish to design and implement tobacco-use interventions for patients admitted with presumptive acute myocardial infarction.
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