Clinical question
How effective are psychosocial interventions for smoking cessation in patients with coronary heart disease (CHD)?
Bottom line
After a cardiac event about 30% to 50% of smokers with CHD quit without professional help. Additional psychosocial interventions showed a superior quitting rate (NNT* 14.9) compared to usual care in the short-term (six to 12 months). Long-term (>12 months) follow-up showed an attenuation in the benefit of psychosocial interventions for smoking cessation. Interventions consisted of behavioural therapeutic approaches, telephone support and self-help material. Brief interventions were not effective. Adverse effects were not reported in any trial.
*NNT = number needed to treat to benefit one individual.
Caveat
The trials mostly included older male patients with CHD, predominantly myocardial infarction. Heterogeneity between trials was substantial.
Context
Smoking increases the risk of developing atherosclerosis but also acute thrombotic events. Quitting smoking is potentially the most effective secondary prevention measure and improves prognosis after a cardiac event, but more than half of these patients continue to smoke, and improved cessation aids are urgently required.
Cochrane Systematic Review
Barth J et al. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Reviews, 2015, Issue 7. Art. No.: CD006886.DOI: 10.1002/14651858. CD006886.pub2. This review contains 40 studies involving 7,682 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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