ACCEPTABILITY AND EFFICACY OF A SYSTEMATIC SMOKING CESSATION INTERVENTION USING MOTIVATIONAL INTERVIEWING FOR SMOKERS HOSPITALIZED FOR ACUTE CORONARY SYNDROMES

Purpose: Current guidelines recommend smoking cessation interventions to all smokers hospitalized with acute coronary syndromes (ACS). In clinical practice, intensive smoking cessation interventions are not systematically proposed. A proactive strategy using motivational interviewing, a non-judgmental, patient-centered counseling, may be suited to approach all smokers regardless of their readiness to quit. We aimed at testing the acceptability and efficacy of a systematic, intensive smoking cessation intervention using motivational interviewing to all smokers hospitalized for ACS.

Method: We compared counseling and one-year smoking cessation rates before and after implementation of systematic smoking cessation intervention in 2 Swiss university hospitals for 457 smokers hospitalized for ACS. We further compared smoking cessation rates in 96 smokers with ACS from a third Swiss university hospital not providing systematic smoking intervention during the entire study period. In the observation phase, clinicians requested a specialized smoking cessation intervention based on their appraisal of the patient’s needs. In the intervention phase, a resident physician trained in motivational interviewing offered help for smoking cessation to all smokers. After discharge, smokers also received four telephone counseling sessions over two months.

Result: In the observational phase (August 2009 to October 2010), 24% (N=47/225) of smokers received a specialized smoking cessation intervention. In the intervention phase (November 2010 to February 2012), 84% (N=188/223) had an intervention (p<0.001) and 76% had at least one telephone counseling. In the intervention phase, less than 2% of smokers refused the intervention and 14% were discharged before the resident could approach them. The median duration of counseling in the hospital was 50 minutes (interquartile range 25 minutes). At one year, data on smoking status were available for 96% of participants, while abstinence was validated by expired CO measurement in 80% of quitters. In the observation phase 42% had stopped smoking vs. 52% in intervention phase (p=0.05). In the control hospital without systematic smoking intervention, contemporary smoking cessation rates at one year were 45% for the observation period and 40% for the intervention period (p=0.6).

Conclusion: A proactive strategy offering a specialized smoking cessation intervention based on motivational interviewing to all smoking patients hospitalized for ACS is well accepted. Compared to a reactive strategy, it significantly increases the delivery of smoking cessation interventions and smoking abstinence one year after an ACS.