Intensive Smoking Cessation Intervention Reduces Mortality in High- Risk Smokers With Cardiovascular Disease*

Purpose: To compare an intensive smoking cessation intervention against usual care in hospital-ized high-risk smokers with acute cardiovascular disease. Methods: A total of 209 hospitalized smokers were randomized to the intensive intervention (n 109) or to usual care (n 100). Usual care consisted only of counseling and printed educational material provided prior to hospital discharge. Intensive treatment consisted of a minimum of 12 weeks of behavior modification counseling and individualized pharmacotherapy provided at no cost to the participant. Smoking status in all subjects was confirmed biochemically (ie, by measuring expired carbon monoxide) at 3, 6, 12, and 24 months after randomization. Outcomes included point prevalence and continuous abstinence smoking cessation rates, hospi-talizations, and all-cause mortality. Results: At each follow-up interval, point prevalence and continuous abstinence smoking cessation rates were significantly greater in the intensive-treatment group compared to the usual-care group. At 24 months, continuous abstinence smoking cessation rates were 33 % in the intensive-treatment group and 9 % in the usual-care group (p < 0.0001). Over the 2-year follow-up period, 41 patients in the usual-care group were hospitalized compared to 25 patient