Smoking abstinence 1 year after acute coronary syndrome in Tunisian adults

Abstract

Background In Tunisia, coronary heart disease(CHD) is the first cause of mortality, accounting one third (33.23%) of total deaths in 2017. Although smoking cessation is the most effective CHD prevention strategy, quitting smoking is difficult and two thirds of patients return to smoking within 1 year of their acute coronary syndrome (ACS). The present study aimed to evaluate the smoking cessation rate and to assess predictors of smoking abstinence in patients with ACS, one year after hospital discharge. Methods A prospective cohort study was conducted in the Cardiology Department and Smoking Cessation Service at University Hospital of Monastir, Tunisia from January 2015 to December 2017. During their hospitalization, all patients in the sample received individual therapeutic education including a motivational interview. The follow-up were carried out by clinic visits every two weeks. Logistic regression analysis was used to evaluate the independent predictors of smoking abstinence. The statistical analysis was conducted with SPSS software, version 21.0. A p value of < 0.05 was considered statistically significant. Results A total of 288 smoking patients were included in our study. All participants were male and the mean age was 55 ± 11 years. More than half (55.4%) of patients had a high level of nicotine dependence. Successful smoking cessation rate was 35.7 % [95% confidence interval (CI): 29.4-42.5%]. Independent predictors of smoking abstinence were: therapeutic adherence (odds ratio(OR): 13.8, p < 0.001), the level of nicotinic dependence (OR: 0.26, p = 0.02), the length of stay in the ICU (OR: 8.31, p = 0.001) and diabetic status (OR: 4.54, p = 0.01). Conclusions This study for smoking cessation highlights the importance to generalize our protocol for all Tunisian patient with cardiovascular risk. Key messages Smoking cessation is the most effective coronary heart disease prevention strategy. More efforts are required to improve smoking cessation in patients with cardiovascular risk.