title: Smoking cessation interventions following acute coronary syndrome: a missed opportunity?
abstract: BACKGROUND
  It is recommended that general practitioners (GPs) offer cessation advice and pharmacological interventions to smokers with acute coronary syndrome (ACS). The study objective was to describe the extent to which this is done, and to describe outcomes by smoking status.
  
  
  METHODS
  Patients aged 30+ hospitalised for troponin-positive ACS from 2002 to 2009, discharged home alive, were identified in the Myocardial Ischaemia National Audit Project registry. Patient data were linked to the General Practice Research Database, Hospital Episode Statistics, and Office of National Statistics mortality data, enabling a unique perspective of longitudinal smoking data. Patients who smoked prior to the hospitalisation had GP interventions and quitting status established in the 3 months following discharge, and were followed up for major clinical outcomes.
  
  
  METHODS
  The outcomes evaluated included death, repeat ACS, stroke, heart failure, and major adverse cardiac events (MACE).
  
  
  RESULTS
  Of the 4834 patients included, 965 (20%) were smokers at the time of their ACS. After the ACS event, only 225 (24%) received any GP smoking intervention within 3 months, with 82 (9%) receiving advice only, and 143 (15%) receiving a pharmacological intervention. Patients who quit (320; 33%) were at a decreased risk of mortality (relative risk (RR) 0.49; 95% confidence interval (CI) 0.35-0.69) and MACE (RR 0.61; 0.46-0.80) compared with patients who did not.
  
  
  CONCLUSIONS
  Whilst a high proportion of patients with ACS are smokers, there is a low level of GP cessation intervention following hospital discharge. This missed opportunity of patient care is important given the decreased risk of mortality and MACE found amongst those who quit.
authors.affiliation: General Practice Research Database, MHRA, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Boggon
authors.affiliation: Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Department of Epidemiology & Public Health, University College London, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.affiliation: Pfizer Ltd, Sandwich, UK.
authors.forename: Sunil
authors.initials: S
authors.lastname: Raju
authors.affiliation: Pfizer Ltd, Sandwich, UK.
authors.forename: Franco Mondello
authors.initials: FM
authors.lastname: Malvestiti
authors.affiliation: General Practice Research Database, MHRA, London, UK tjeerd.vanstaa@mhra.gsi.gov.uk.
authors.forename: Tjeerd P
authors.initials: TP
authors.lastname: Van Staa
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016540:Smoking Cessation; D020521:Stroke / Q000517:prevention & control