Life Years Gained From Smoking-Cessation Counseling After Myocardial Infarction.
BACKGROUND
Hospitalization for acute myocardial infarction (AMI) is an opportune time to counsel smokers to quit. Studies have demonstrated lower short-term mortality for counseled versus non-counseled smokers; yet, little is known about the long-term survival benefits of post-AMI smoking-cessation counseling (SCC).


METHODS
Data from the Cooperative Cardiovascular Project, a prospective cohort study of elderly patients with AMI between 1994 and 1996 with >17 years of follow-up, were used to evaluate the association of SCC with short- and long-term mortality in smokers with AMI. Life expectancy and years of potential life gained were used to quantify the long-term survival benefits of SCC. Cox proportional hazards models with exponential extrapolation were used to estimate life expectancy.


RESULTS
The analysis included 13,815 smokers, of whom 5,695 (41.2%) received SCC. Non-counseled smokers had higher crude mortality than counseled smokers over all 17 years of follow-up. After adjustment for patient and hospital characteristics, SCC was associated with a 22.6% lower 30-day mortality and a 7.5% lower mortality over 17 years. These survival differences produced higher life expectancy estimates for counseled smokers than non-counseled smokers at all ages, which resulted in average gains in life years of 0.13 (95% CI=-0.31, 0.56) to 0.58 (95% CI=0.25, 0.91) years, with the largest gains observed in older smokers.


CONCLUSIONS
SCC is associated with longer life expectancy and gains in life years in elderly smokers with AMI, supporting the importance of post-AMI counseling efforts.
Yale School of Medicine, New Haven, Connecticut; Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
Emily M
EM
Bucholz
Yale College, New Haven, Connecticut.
Adam L
AL
Beckman
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Catarina I
CI
Kiefe
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Medicine, New Haven, Connecticut; Section of Health Policy and Administration, School of Public Health, Yale School of Medicine, New Haven, Connecticut. Electronic address: harlan.krumholz@yale.edu.
Harlan M
HM
Krumholz
D000368:Aged; D015331:Cohort Studies; D003376:Counseling; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D016540:Smoking Cessation; D014481:United States / Q000453:epidemiology
J Am Coll Cardiol. 2008 Dec 9;52(24):2046-99
19056000
Circulation. 1997 Nov 4;96(9):3243-7
9386200
CMAJ. 2009 Jun 23;180(13):1297-303
19546455
Br Med J (Clin Res Ed). 1983 Jul 30;287(6388):324-6
6409291
Ann Intern Med. 1990 Sep 1;113(5):343-51
2382916
Am J Med. 1994 Sep;97(3):242-9
8092173
Cochrane Database Syst Rev. 2012 May 16;(5):CD001837
22592676
Heart Dis Stroke. 1992 Jul-Aug;1(4):173-5
1344104
Am J Epidemiol. 2002 Dec 1;156(11):994-1001
12446255
Arch Intern Med. 1997 Feb 24;157(4):409-15
9046892
Ann Intern Med. 1990 Jul 15;113(2):118-23
2360750
Am Heart J. 2007 Aug;154(2):213-20
17643569
Int J Cardiol. 1994 Apr;44(2):151-6
8045660
Tob Control. 1997;6 Suppl 2:S57-62
9583654
Int J Cardiol. 2013 Jul 1;166(3):748-9
23084814
Prev Med. 1998 Sep-Oct;27(5 Pt 1):720-9
9808804
Circ J. 2005 Jan;69(1):7-12
15635194
Prev Med. 1991 Sep;20(5):590-601
1758840
J Am Coll Cardiol. 2011 Nov 29;58(23):2432-46
22055990
Arch Intern Med. 2008 Oct 13;168(18):1961-7
18852396
J Am Coll Cardiol. 2009 Dec 15;54(25):2382-7
20082928
Tob Control. 2000 Dec;9(4):382-8
11106707
J Hosp Med. 2009 Mar;4(3):E3-9
19301384
Eval Health Prof. 1998 Dec;21(4):442-60
10351558
Eur J Cardiovasc Prev Rehabil. 2005 Oct;12(5):472-7
16210934
Arch Intern Med. 2011 Jun 27;171(12):1055-60
21403011
Arch Intern Med. 2000 Apr 10;160(7):939-44
10761958
J Am Coll Cardiol. 2013 Feb 5;61(5):533-5
23369418
Mayo Clin Proc. 1998 Mar;73(3):205-9
9511776
J Am Coll Cardiol. 2010 May 4;55(18):1988-95
20236788
JAMA. 1991 Dec 11;266(22):3139-44
1956100
BMJ. 2003 Nov 29;327(7426):1254-7
14644967
Addict Behav. 1990;15(6):549-52
2075852
Am J Prev Med. 2004 Jun;26(5):391-401
15165655
Am J Med. 2006 Dec;119(12):1080-7
17145253
Eur Heart J. 2004 Dec;25(23):2101-8
15571825
Chest. 2007 Feb;131(2):446-52
17296646
JAMA. 2003 Jul 2;290(1):86-97
12837716
Am J Med. 2005 Mar;118(3):269-75
15745725
J Am Coll Cardiol. 2013 Feb 5;61(5):524-32
23369417
Prev Med. 1995 Mar;24(2):201-12
7597023
Am J Prev Med. 2004 Feb;26(2):112-8
14751321
Postgrad Med J. 1992 Jul;68(801):562-5
1437954
Am J Cardiol. 2015 Feb 15;115(4):405-10
25541324
Addiction. 2001 Mar;96(3):485-94
11255587
Circulation. 2013 Jan 29;127(4):e362-425
23247304
JAMA. 1998 May 6;279(17):1351-7
9582042