Electronic letters to:

Research:
Patricia M. Smith and Ellen Burgess
Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial
CMAJ 2009; 180: 1297-1303 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Smoking cessation programs and myocardial infarction: Who care for RCT?
Alain Braillon   (30 June 2009)

Smoking cessation programs and myocardial infarction: Who care for RCT? 30 June 2009
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Alain Braillon
Public Health, University hospitals of Amiens, place Victor Pauchet, 80000 Amiens; France

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Re: Smoking cessation programs and myocardial infarction: Who care for RCT?

braillon.alain{at}chu-amiens.fr Alain Braillon

Smith and Burgess concluded from their randomized controlled trial (RCT) that intensive interventions for smoking cessation must be disseminated into standard hospital practice for cardiac patients.[1]

Indeed, the potential contributions to health are substantial. Smoking is still the first avoidable cause of myocardial infarction (MI) recurrence: from EUROASPIRE 1995–6 to 2006-7 (a collation of indicators in European countries on treatments and risk factors one year after MI), the proportion of patients who smoke has remained nearly the same (20 to 18%) and the proportion of women smokers has increased.[2]

However, there is little hope for improvement. Recently, the editor of the Lancet wrongly encouraged cardiologists to give brief advice about quitting smoking after MI.[3] Moreover, he refused to publish a short letter which stressed that a RCT showed that brief advice has no effects in these specific patients who need institutional smoking cessation programs.[4] In France, despite its ineffectiveness, giving a brief advice about quitting smoking after MI is a mandatory indicator for the quality and security of care in the accreditation program run by the Healthcare watchdog! Moreover, the prescription of pharmacological treatments against smoking suffer from a complex and very limited (50 €) reimbursement scheme whereas homeopathic products are fully reimbursed.

Who can explain this chronic denial?

1 Smith PM, Burgess E. Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial. CMAJ. 2009;180:1283-4.

2 Kotseva K, Wood D, De Backer G, et al. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet. 2009;373:929-40

3 Editorial. Cardiologists should be less passive about smoking cessation. Lancet. 2009;373:867.

4 Dawood N, Vaccarino V, Reid KJ, Spertus JA, Hamid N, Parashar S, for the PREMIER Registry Investigators. Predictors of smoking cessation after a myocardial infarction. The role of institutional smoking cessation programs in improving success. Arch Intern Med. 2008; 168:1961-7.

Conflict of Interest:

None declared