Life Years Gained From Smoking-Cessation Counseling After Myocardial Infarction
Department of Quantitative Health Sciences
Cardiovascular Diseases | Community Health and Preventive Medicine | Preventive Medicine | Substance Abuse and Addiction
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.
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Citation: Am J Prev Med. 2017 Jan;52(1):38-46. Epub 2016 Sep 28. Link to article on publisher's site
Bucholz, Emily M.; Beckman, Adam L.; Kiefe, Catarina I.; and Krumholz, Harlan M., "Life Years Gained From Smoking-Cessation Counseling After Myocardial Infarction" (2017). University of Massachusetts Medical School Faculty Publications. 1277.