Background: Cardiac rehabilitation programs (CRP) are class I indication in clinical guidelines as they have proved to be a cost-effective secondary prevention intervention. One of their main goals is to achieve smoking cessation since it has shown to reduce the risk of mortality by 33% in patients with coronary artery disease. Objectives and
Methods: Data were collected retrospectively of 573 smokers referred to a CRP between May 2006 and January 2015 after having suffered an acute coronary syndrome. Our objective is to determine the critical success factors of the program measuring by co-oximetry the abstinence rate at 3 months and evaluating its impact on other factors.
Results: 84.5% were male, with a mean age of 53,37±9,74 years. The average of pack years of cigarette smoking was 43.53. Every patient (P.) attended briefings, being also necessary pharmacological treatment prescription in 21.2% of the patients (varenicline (V) was used in 11.3%; bupropion (Bp) in 1%, nicotine replacement therapy (NRT) in 4.3%, NRT and one drug in 3.3% and NRT and two drugs in 1.2%). Pharmacological treatment use was more common among women, young patients and those with higher pack-year consumption (p<0.05). At the third month, 437 P. (80%) had quitted smoking (88.9% of patients who were not treated with drugs and 48.5% of patients who needed pharmacological treatment, p<0.05). In this subgroup, 65% of patients treated with V or Bp left tobacco consumption in comparison to 28.6% of P. treated with NRT and 22.4% of P. treated with both therapies. Sex, age, obesity and other risk factors did not influence abstinence rates whereas higher pack-year consumption was significantly associated with less success (41,31 vs 52,90, p=0,03). The persistence of smoking implied less functional capacity (10,06 METS vs 10,76, p=0,02) and higher CRP dropout rates (31,4% vs 5,4%; p<0,05); however it did not affect weight, blood pressure values, glycosilated hemoglobin or lipid levels at discharge.
Conclusion: CRP achieve high rates of smoking cessation; in our experience the most effective interventions are motivational support and varenicline (if pharmacological treatment is necessary). A higher pack year consumption reduced the likelihood of abstinence at 3 months.