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Smoking relapse deadly for stroke survivors.

MUNICH--Patients who resume smoking after an ischemic stroke raise their risk of dying by roughly threefold within 1 year, a prospective, observational study has shown.

Moreover, the risk of dying increases the sooner the relapse occurs. Patients who resume smoking within 10 days of leaving the hospital are five times more likely to die within a year than are those who remain smoke free, said Dr. Furio Colivicchi of San Filippo Neri Hospital, Rome.

Cardiologists at San Filippo, in collaboration with neurologists from the Santa Lucia Foundation of Rome, enrolled 921 consecutive active smokers who ceased smoking after admission to the hospital for acute ischemic stroke and reported being motivated to continue abstaining once discharged.

All patients received a brief in-hospital smoking cessation counseling session lasting 5-20 minutes and delivered by trained nurses (73%) or physicians (27%).

Patients did not receive any specific postdischarge support or pharmacotherapy for smoking cessation. One-third of patients (34%), however, were referred to a hospital-based rehabilitation program after their stroke.

The cohort of 584 men and 337 women had an average National Institutes of Health Stroke Scale score of 9.1, 11% had had a previous stroke, 18% had a previous myocardial infarction, 69% had hypertension, and 20% were obese. Their average age was 67 years.

During the 12-month follow-up, 54% of all patients resumed regular cigarette smoking, with 50% relapsing within 3 weeks of discharge.

Patients who relapsed were significantly more likely to be older (69 years vs. 65 years) and female (44% vs. 28%), and were less likely to relapse if referred to a hospital-based stroke rehabilitation program (25% vs. 44%). All differences were highly significant.

During the 12-month follow-up, 89 patients (9.7%) died. Most of the deaths were due to ischemic events, both coronary and stroke recurrences, Dr. Colivicchi told the media at the meeting.

After adjustment for confounding clinical variables and variables related to the acute event, a strong relationship was found between smoking relapse and all-cause mortality Dr. Colivicchi said. The risk of death was 5.1-fold higher at 19 days, 3.8-fold higher at 120 days, and 2.6-fold higher at roughly 1 year.

Most of the patients in the study were heavy smokers, smoking more than 10 cigarettes per day prior to the index event and typically relapsing to their original amount. "We must be very careful and provide a more comprehensive approach because individual counseling is not fully effective if it is not followed by postdischarge support for this specific problem and possibly, in selected cases, by pharmacological treatment aimed at reducing the risk of relapse," he said.

A recent study in 4,834 patients with acute coronary syndrome reported that only 24% of smokers received any smoking intervention within 3 months of the event. Of these, 9% received advice only and 15% received pharmacological intervention (Eur. J. Prey. Cardiol. 2012 Sept. 5 [epub ahead of print]).

Dr. Colivicchi reported no relevant financial conflicts.


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Title Annotation:NEUROLOGY
Author:Wendling, Patrice
Publication:Internal Medicine News
Article Type:Clinical report
Date:Nov 1, 2012
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