Why are heart patients who smoke leaving hospital still smoking?

by Carolyn Thomas    ♥   @HeartSisters

If you ever needed a swift smack upside the head to convince you to finally stop smoking once and for all, you’d think that a heart attack would do it.

Hospitalized survivors, shocked and traumatized, are already lying there in the cardiac ward unable to light up, and certainly prohibited from smoking anywhere inside the hospital buildings. In my town, smoking is banned on all hospital grounds, thus requiring a long walk clear across the street to huddle near the bus stop – if the patient is mobile enough – with the attractive hospital gown flapping in the wind behind. These smokers are already well underway, whether they’d planned it or not, to quitting cold turkey. So why are they starting up again by the time they get home?

What many non-smokers may not understand about this question is that smokers generally LOVE their smokes. They love the longstanding associations between a cigarette and their daily routines. They love that first early morning cigarette. Or coffee breaks with workmates. On the phone. At parties. That last smoke of the day out on a quiet porch.

Smokers on the cardiac ward already know that smoking is likely what landed them in that cardiac ward in the first place. Just in case, here’s why smoking is so damaging to the heart:

• it speeds up progression of atherosclerosis (plaque formation)
• it alters cholesterol – more LDL (bad) cholesterol and less HDL (good)
• it increases heart muscle oxygen demand by at least 10%
• it reduces coronary artery blood flow due to adrenaline release
• it diminishes blood flow in our smallest coronary  blood vessels
• it interferes with the medicines that heart patients take to prevent angina pain
• it alters the clotting mechanism of blood platelets
• it causes endothelial cell dysfunction in the lining of coronary arteries, with reduced ability to produce chemicals that dilate the arteries

Sir Richard Peto, known as the ‘rockstar epidemiologist’ from the University of Oxford, claims that smoking is the absolute biggest risk factor in heart disease. He suggests:

“If you want to kill yourself, start smoking early, and don’t quit.”

Many smokers are getting the message.They are so gobsmacked after suffering a cardiac event that they do indeed quit smoking, often right on the spot. No patches, no gum, no hypnosis, no support groups.

But almost half of heart attack survivors who are smokers leave the hospital still smoking. Researchers have found that this decision doubles their chances of suffering a repeat heart attack.  

Population studies, by the way, show consistently that about three-quarters of smokers who permanently quit do so without any form of pharmaceutical assistance (like pills, gum, patches, etc.) See also: True or False? Most Smokers Need Help to Quit

Scientists at New York’s Feinstein Institute for Medical Research also claim that just weeks after quitting smoking, women show major reductions in several markers of inflammation (C-reactive protein, tumour necrosis factor, among others) that have been clearly associated with heart disease risk. Because smoking is known to promote inflammation, quitting significantly cuts the risk of mortality for both heart and lung disease.

The American College of Cardiology confirmed last year that a 10-year study following the progress of smokers who suffered heart attacks showed a remarkable decrease in the likelihood of a second heart attack among those patients who had participated in an intensive stop-smoking education program while still in hospital.

Dr. Patricia Smith of the Northern Ontario School of Medicine reported in the Canadian Medical Association Journal that three factors appear to influence longterm success in quitting post-heart attack. In addition to receiving the intensive intervention in hospital, successful longterm results were also influenced by:

• the absence of a previous acute heart attack
• having a post-secondary education
• restrictions on smoking at home

I’d interpret that last important factor as blanket permission to lay down the law at home if you have a smoking heart patient under your roof.  (Cities that have legislated bans on smoking in public places, for example, have been remarkably effective in getting smokers to quit just by making it so darned difficult to find a place that tolerates them. I suspect that these smokers didn’t quit because they read a helpful pamphlet of tips from their local lung association, but because they couldn’t stand feeling ostracized and shamed.) The question “Do you mind if I smoke?” was rarely if ever greeted with a polite answer anymore. 

Would a quit-smoking education program that starts while a heart patient is still hospitalized just be another added financial burden on the health care system?   An earlier Norwegian study suggests that the cost is a small investment in health now compared to the big cost of treating future heart attacks later.  In other words, our health care systems can’t afford NOT to routinely offer smoking cessation programs in cardiac wards.

The study in Norway also found that program costs compare favourably to other standard treatments for heart patients in hospital.  For example, such programs would be approximately 1/25 the cost of offering both statins and ACE inhibitor drugs (both commonly given to cardiac patients).

The Norwegian conclusion: a nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatments in patients with coronary heart disease.

Find out more about the Canadian Medical Association Journal study, or read this report called “The Role of Cigarette Smoking and Gender in Acute Coronary Syndrome“ published in the American Journal of Cardiology.

© Carolyn Thomas  www.myheartsisters.org

See also:

True or False? Most Smokers Need Help to Quit

Why Don’t Patients Listen to Doctors’ Heart-Healthy Advice?

Why the Poor Pay Virtually No Attention to Quit Smoking Campaigns

Too Many Smokers Are Quitting on their Own – so Pfizer Pays Doctors to Plug Their Nicorette Gum

Cigarette Smoking a Greater Risk for Women’s Heart Health – The Lancet

Stop-Smoking Drug Chantix/Champix Linked to Heart Risks – Canadian Medical Association Journal