Nov. 12, 1998 DALLAS, Nov. 11 -- Almost three in five smokers who undergo surgery for heart disease continue to smoke after their procedure, according to a study presented today at the American Heart Association's 71st Annual Scientific Sessions. "We were surprised by the finding that so many people continued to smoke after surgery," says presenting author Bonnie H. Weiner, M.D., professor of medicine and medical director, Center for Research in Invasive and Interventional Cardiology at the University of Massachusetts Medical School, Worcester. Individuals in the study had undergone either angioplasty, a procedure to re-open blocked blood vessels, or coronary artery bypass surgery which uses artery or vein grafts to route blood around a blockage.
"We thought that individuals who needed the operations would have been shaken up enough to stop -- but that was not the case for almost 60 percent," Weiner says. "It was their first procedure, but many had a long history of heart disease." In this study, it was up to physicians and nurses to encourage patients to stop smoking by referring them to programs, says lead author Sheryl F. Kelsey, Ph.D., an epidemiologist at the University of Pittsburgh Graduate School of Public Health.
"In the past, patients tended to stay in the hospital for at least two weeks, and that gave physicians more opportunity to educate them about the need to quit. Back then they had a captive audience. Today, patients are in and out." Researchers examined a group of 1,829 individuals who had bypass surgery or angioplasty. Weiner and her colleagues sought to determine which individuals were most likely to continue smoking. In the study, about 25 percent were smokers and about 44 percent were former smokers who had quit prior to their procedure.
At a five-year follow-up, the researchers found that just over 40 percent of active smokers had quit smoking. Individuals were defined as "permanent quitters" if they had not smoked since their procedure. Researchers characterized those who did not quit as "die-hard" smokers.
The researchers found that younger patients and African Americans were more likely to be "die-hard" smokers, as were those with a prior history of heart attack and those with poor or fair self-rated general health. Individuals who had high blood pressure or diabetes were less likely to be "die-hard" smokers.
"The black population has been identified in many prevention studies as being especially at risk for smoking-related illnesses, including heart disease," Kelsey says. "We need to pay special attention to these findings -- blacks represent a specific target for our intervention efforts."
Smoking patterns did not differ between men and women, and compared to non-smokers, smokers did not have higher cholesterol, a blood fat that can increase the risk of heart attacks. Individuals who were married or were living with a partner were more successful in kicking their smoking habit and less likely to have smoked at any time, the researchers report.
Older patients and those who reported they were healthy prior to surgery were also less likely to smoke. Patients who underwent bypass surgery were less likely to be "die-hard" smokers than those who had angioplasty.
Individuals who stopped smoking shortly before their angioplasty or bypass surgery were more prone to start smoking again during the follow-up period, says Kelsey.
"Maybe it was short-term panic about their need for an operation that made them quit for a short period," she explains. "We know that individuals who stopped smoking years earlier were far less likely to resume."
Kelsey says smoking cessation education may be compromised because healthcare workers are limited in the time they spend with patients.
The study participants were enrolled in the Bypass and Angioplasty Revascularization Investigation (BARI) study, a multicenter study funded by the National Heart, Lung, and Blood Institute. BARI, which began examining outcomes of angioplasty and heart bypass procedures in 1988, includes smoking cessation guidelines as part of its protocol, but does not include formal intervention programs.
Co-authors are Helen A. Vlachos, M.S.; Vera Bittner, M.D.; William Feng, M.D.; Sylvia Matheson, R.N.; Johanne Trudel, R.N.; Bertram Pitt, M.D.; and Alice K. Jacobs, M.D.
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