Effect of in-hospital nurse-led smoking cessation intervention for patients with atherosclerotic cardiovascular disease: a randomised pilot study

Abstract

Background: Smoking remains prevalent after cardiovascular disease (CVD) events and knowledge on how to facilitate effective cessation in clinical practice is needed. Purpose: To test the effect of an in‐hospital nurse‐led intervention on the participation rate at municipal Healthy Life Centres (HLC) and the use of smoking cessation drugs. Secondary, to determine long‐term effects on cessation rates. Methods: A prospective, randomized, open‐label, parallel‐group intervention pilot‐study was conducted at a Norwegian secondary care hospital in 2021. Patients with atherosclerotic CVD who smoked at least one cigarette daily when admitted with an acute CVD event were consecutively included. The nurse‐led intervention included cessation counselling utilizing motivational interview technique, information and guidance in proper use of cessation drugs and direct referral to a 12‐weeks digital (video ± phone) HLC program where patients received free cessation drugs. The low‐threshold intervention included written information about the offer in the HLC with free cessation drugs. The primary endpoints were between‐group differences in attendance rates at the HLC program and the use of cessation drugs. Results: Of 99 potential participants, 24 did not meet the entry criteria whereas 17 declined to participate. Of 58 randomised patients, three died during follow‐up and 55 completed the study. Mean age was 65.7 (SD 9.2) years, 35% were female, 88% had low education, 88% had smoked >20 years, and motivation for quitting smoking was high (mean 8.5 on a 0 [no motivation] to 10 [high motivation] Likert scale). Comorbidity was common (mean Charlson score 5.1) and 40% had symptoms of anxiety and/or depression. The nurse‐led intervention resulted in significantly higher participation rate at the HLC (48% vs. 4%, difference: 44% [95% CI: 24%, 65%], P<0.0001) and more frequent use of cessation drugs (48% vs. 11%, difference: 37% [95% CI: 15%, 60%], P=0.002) compared to the lowthreshold intervention (Figure A). All participants in the intervention group who attended the HLC program were offered follow‐up within 21 days following randomisation. In the intervention group 15% used varenicline and 33% used a combination of short and long‐acting nicotine replacements. Clinically significant differences in cessation rates after six months were observed between the groups (Figure B). Concomitant carbon monoxide measurements were obtained of 5 participants in the intervention group and 4 in the control group who reported cessation and all confirmed nonsmoking. Conclusion: Among multi‐morbid patients hospitalised for a CVD event, a nurse‐led intervention resulted in substantially higher participation rate at a municipal HLC program and higher use of smoking cessation drugs compared to written information. We also found clinically significant long‐term effects on cessation rates which needs to be confirmed in a large‐scale study.