Emily M Bucholz1, Adam L Beckman2, Catarina I Kiefe3, Harlan M Krumholz4. 1. Yale School of Medicine, New Haven, Connecticut; Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. 2. Yale College, New Haven, Connecticut. 3. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. 4. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Medicine, New Haven, Connecticut; Section of Health Policy and Administration, School of Public Health, Yale School of Medicine, New Haven, Connecticut. Electronic address: harlan.krumholz@yale.edu.
Abstract
INTRODUCTION: Hospitalization for acute myocardial infarction (AMI) is an opportune time to counsel smokers to quit. Studies have demonstrated lower short-term mortality for counseled versus non-counseled smokers; yet, little is known about the long-term survival benefits of post-AMI smoking-cessation counseling (SCC). METHODS: Data from the Cooperative Cardiovascular Project, a prospective cohort study of elderly patients with AMI between 1994 and 1996 with >17 years of follow-up, were used to evaluate the association of SCC with short- and long-term mortality in smokers with AMI. Life expectancy and years of potential life gained were used to quantify the long-term survival benefits of SCC. Cox proportional hazards models with exponential extrapolation were used to estimate life expectancy. RESULTS: The analysis included 13,815 smokers, of whom 5,695 (41.2%) received SCC. Non-counseled smokers had higher crude mortality than counseled smokers over all 17 years of follow-up. After adjustment for patient and hospital characteristics, SCC was associated with a 22.6% lower 30-day mortality and a 7.5% lower mortality over 17 years. These survival differences produced higher life expectancy estimates for counseled smokers than non-counseled smokers at all ages, which resulted in average gains in life years of 0.13 (95% CI=-0.31, 0.56) to 0.58 (95% CI=0.25, 0.91) years, with the largest gains observed in older smokers. CONCLUSIONS: SCC is associated with longer life expectancy and gains in life years in elderly smokers with AMI, supporting the importance of post-AMI counseling efforts.
INTRODUCTION: Hospitalization for acute myocardial infarction (AMI) is an opportune time to counsel smokers to quit. Studies have demonstrated lower short-term mortality for counseled versus non-counseled smokers; yet, little is known about the long-term survival benefits of post-AMI smoking-cessation counseling (SCC). METHODS: Data from the Cooperative Cardiovascular Project, a prospective cohort study of elderly patients with AMI between 1994 and 1996 with >17 years of follow-up, were used to evaluate the association of SCC with short- and long-term mortality in smokers with AMI. Life expectancy and years of potential life gained were used to quantify the long-term survival benefits of SCC. Cox proportional hazards models with exponential extrapolation were used to estimate life expectancy. RESULTS: The analysis included 13,815 smokers, of whom 5,695 (41.2%) received SCC. Non-counseled smokers had higher crude mortality than counseled smokers over all 17 years of follow-up. After adjustment for patient and hospital characteristics, SCC was associated with a 22.6% lower 30-day mortality and a 7.5% lower mortality over 17 years. These survival differences produced higher life expectancy estimates for counseled smokers than non-counseled smokers at all ages, which resulted in average gains in life years of 0.13 (95% CI=-0.31, 0.56) to 0.58 (95% CI=0.25, 0.91) years, with the largest gains observed in older smokers. CONCLUSIONS: SCC is associated with longer life expectancy and gains in life years in elderly smokers with AMI, supporting the importance of post-AMI counseling efforts.
Authors: D S Sheps; M C Herbst; A L Hinderliter; K F Adams; L G Ekelund; J J O'Neil; G M Goldstein; P A Bromberg; J L Dalton; M N Ballenger Journal: Ann Intern Med Date: 1990-09-01 Impact factor: 25.391
Authors: Harlan M Krumholz; Jeffrey L Anderson; Brian L Bachelder; Francis M Fesmire; Stephan D Fihn; JoAnne M Foody; P Michael Ho; Mikhail N Kosiborod; Frederick A Masoudi; Brahmajee K Nallamothu Journal: J Am Coll Cardiol Date: 2008-12-09 Impact factor: 24.094