BackgroundCardiovascular disease (CVD) prevention guidelines stress the importance of smoking cessation and recommend intensive follow-up. To guide the development of such cessation support strategies, we analysed the characteristics that are associated with successful smoking cessation after an acute coronary syndrome (ACS).MethodsWe used data from the Randomised Evaluation of Secondary Prevention for ACS patients coordinated by Outpatient Nurse SpEcialists (RESPONSE) trial (n = 754). This was designed to quantify the impact of a nurse-coordinated prevention program, focusing on healthy lifestyles, traditional CVD risk factors and medication adherence. For the current analysis we included all smokers (324/754, 43 %). Successful quitters were defined as those who reported abstinence at 1 year of follow-up.ResultsThe majority of successful quitters quit immediately after the ACS event and remained abstinent through 1 year of follow-up, without extra support (128/156, 82 %). Higher education level (33 vs. 15 %, p < 0.01), no history of CVD (87 vs. 74 %, p < 0.01) and being on target for LDL-cholesterol level at 1 year (78 vs. 63 %, p < 0.01) were associated with successful quitting.ConclusionThe majority of successful quitters at 1 year stopped immediately after their ACS. Patients in this group showed that it was within their own ability to quit, and they did not relapse through 1 year of follow-up. Our study indicates that in a large group of patients who quit immediately after a life-threatening event, no relapse prevention program is needed.
Background: Blended face-to-face and web-based treatment is a promising mode to deliver smoking cessation treatment. In an outpatient clinic in a Dutch Hospital effectiveness of a blended treatment (BSCT) was compared to usual face-to-face treatment (F2F). The results from 6 months post-treatment follow-up are presented here.Methods: In this open-label two-arm non-inferiority RCT patients (N=344) of a Dutch outpatient smoking cessation clinic were assigned either to the blended smoking cessation treatment (BSCT, N=167) or a face-to-face treatment with identical ingredients and duration (F2F, N=177). CO-validated point prevalence abstinence at 6 months follow-up, taken shortly after end of treatment was analyzed. Intention-to-treat analyses were performed, retaining missing participants as continuing smokers. Non-inferiority was assessed based on a one-sided margin of five percentage points difference between arms. Additionally, a Bayes Factor was estimated (with a BF>3 supporting non-inferiority, and a <.3 rejecting non-inferiority).Method: At 6 months follow up, 23 BSCT participants (13.8%) and 31 F2F participants (17.5%) were abstinent, with a difference of 3.7% (95%CI: 11.4;-4.0) in favor of F2F. Furthermore, a BF=1.28 was found.Discussion: Based on observed biochemically validated abstinence rates, this RCT suggests that delivering outpatient smoking cessation treatment in a blended mode yields comparable quit rates as full face-to-face treatment mode. However, non-inferiority could not be supported conclusively. Ignoring patient preferences for either of the delivery modes may explain these inconclusive findings.
Blended face-to-face and Web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, in this study, we explored adherence to a new blended smoking cessation treatment (BSCT).
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