A nurse led smoking cessation intervention increased cessation rates after hospital admission for coronary heart disease

摘要

Findings of the study by Quist-Paulsen and Gallefoss are supported by a systematic review, which showed the efficacy of intensive behavioural interventions for smoking cessation in patients admitted to hospital.Although it is important to highlight the valuable role of nurses in reducing coronary risk factors such as smoking, 2 concerns may reduce the usefulness of the findings in clinical practice. The first is a concern about the appropriateness of using fear tactics with cardiac patients,especially because this type of intervention is not among the standard recommendations for effective smoking cessation.A second challenge is that, in the face of a severe, worldwide nursing shortage4 (even more critical among specialties like coronary care), it simply may not be realistic to expect that nurses' time could be spared to regularly telephone patients for up to 5 months after discharge.Although the findings of this study show a difference between groups, 15 patients did not have their final smoking status verified. When the authors counted these as patients who smoked, the absolute risk reduction at 12 months was reduced from 20% to 13% (95% Cl 0% to 26%; number needed to treat 8, Q 4 to 250). This loss to follow up must therefore reduce our confidence that the treatment effect is as large as it first appears.It is possible that mechanisms other than "fear arousal," the central feature of the study intervention, were at play in generating these results. Perhaps the outcome is a result of attention effects, positive feedback, education, support, or a combination of these factors. Further research, including an economic evaluation, is needed before nursing resources are allocated to this intervention.