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 RisksCanadian Medical Association Journal


37 thoughts on “Why are heart patients who smoke leaving hospital still smoking?

  1. My husband had a heart attack 6 months ago, I’ve now found out he had been secretly smoking. I’m disgusted about it, as we went through an horrendous time, why is he finding it so hard to quit?


    1. It’s a big shock to find out this kind of news, and it’s really hard for non-smokers to understand the reasons especially when we compare the smoker’s behaviour to how WE would do things. Scroll down a bit to read the comment from Joanne McIntosh, who sums up the “why” nicely:

      “One of the most disregarded factors of cigarette addiction, is what it gives to the smoker. That factor is COMFORT. That’s right… comfort. That crawl-into-a-black hole-and-pull-the-edges-around-you-comfort.”

      After a “horrendous” time surviving a heart attack, that kind of “comfort” is pretty irresistible. Nicotine addiction is just that – an addiction. There are many effective ways to kick the habit, but the decision to quit must come from the smoker, not from the person judging them. Your husband HAD to keep this a secret because he knew how you’d react. And he likely feels far worse about smoking than you do about discovering that he smokes. It turns out that restarting cigarettes (or not quitting in the first place) is shockingly common. I believe it’s part of a patient’s deep need to just be a person, and not a patient anymore.” Good luck to you and your husband


  2. I have read many posts about smoking, but your blog is really very impressive. We are also giving tips and instructions to stop the smoking in Sweden.

    Liked by 1 person

  3. I started having pain in the middle of my chest that went immediately under my left breast, the pain was unbearable. This seemed to last a long time. I thought was maybe gas pain but I hadn’t eaten anything all day. Whenever I got up, I got dizzy until I thought I would pass out. Today my upper back between my shoulder blades hurts. I can hardly walk, and when I get up I feel very faint. I’ve been under a lot of stress for some time. Reading these articles has helped. I didn’t know back pain had anything to do with your heart. I think I should go the ER and get checked out. Thank you for the information.


    1. Hello Cindy – I’ve edited your comment a bit for space. I’m not a physician so can’t comment on your specific issues, but something is causing these distressing symptoms. Right now, you don’t know if these are heart-related or not, but please seek a medical opinion to help solve this mystery. Best of luck to you…


  4. Ever wonder why some people seem to be able to quit, while others can’t? What exactly IS this cigarette addiction? Here are my thoughts..

    We know that there are three simultaneous reactions…a three-pronged threat, so to speak.
    1) chemical addiction…self-explanatory.
    2) physical addiction…the one chair you sit in…a certain activity…the sense of feeling with a cigarette between your fingers..bringing that hand towards your mouth..the social environment…a certain time of day..
    3) emotional addiction…and this one’s the biggie.

    One of the most disregarded factors of cigarette addiction, is what it gives to the smoker. That factor is COMFORT. That’s right… comfort. That crawl-into-a-black hole-and-pull-the-edges-around-you-comfort.
    If you take a good look at the people who just can’t seem to quit smoking, you may find they derive comfort from smoking that they cannot or will not allow from any other source. I believe it is this ability to transfer sourcing of comfort that determines whether a smoker can successfully quit or not.

    And the more pressure this type of smoker has..the more they need comfort. The more put-downs and derogatory remarks aimed their way..the more they need comfort.
    The more their health fails, the more pain they feel, the more they struggle just to survive…the more comfort they need.

    And thus..the more they smoke.

    Luckily, it is only a small percentage of smokers who are trapped in this vicious cycle. The rest eventually find other factors in their lives, healthy and unhealthy, to replace the comfort-source.

    But for that small percentage…they KNOW what it’s doing to them. They KNOW they will die horribly. They KNOW that others resent them for the perceived “waste” of medical resources. They KNOW they are viewed with contempt and disgust. They see and hear it each day, every day.
    And they also KNOW there’s no hope.

    They will all die, and be replaced by the non-smoking generation..and that’s as it should be. But until that transition takes place, those smokers will suffer from a heck of a lot more than smoking. They will, and do, suffer from the public persecution of everyone who matters to them.. of society.. of peers…of those they look up to…

    And that’s a hell of a way to die.

    Liked by 1 person

    1. Several good points, Joanne. When I worked in hospice palliative care, we built a controversial ventilated smoking porch at the end of our 17-bed inpatient unit despite protests of hospital administration, media and public health officials alike. Our position: a person who’s been smoking for decades is highly unmotivated to abandon this one last source of comfort in the final days or weeks of life. As long as others are not adversely affected by these (literally) last gasps, we supported and acknowledged that reality.


      1. That’s respect and compassion at its finest…Kudos to you Carolyn.

        How I wish that our society would operate under that same kindness. I see it daily… War Vets who had risked their lives for our country, made to stand out in the rain/snow to have a cigarette, while being ridiculed by those remaining inside.

        Patients, signing themselves out of hospitals AMA, simply because they can’t access a smoking room/section when they need it the most.. Needless to say, they almost always end right back up in hospital for their ailments.

        A senior citizen here in London, residing in a seniors residence: She adhered to the smoking section by-laws. But due to construction, the home moved the smoking gazebo further than she could walk. So, she finally had to light up and was subsequently charged. If this wasn’t bad enough..there were horrible comments in the comment section of the newspaper…deriding her, ridiculing her, and much more. And several of those comments were from people who identified themselves as employees of the home.
        These stories and more, are just the tip of the iceberg….and they disgust me far more than someone seeking comfort with a cigarette.

        Due to the very nature of the ciggy smoke…living together in a community presents a challenge to smokers and non smokers. But it’s not an impossibility…and there’s no excuse for the despicable treatment that smokers receive.

        Thanks for your compassionate response, Carolyn..I wish more people were like you. Smoking is a very bad thing…we know this. But that doesn’t mean it’s acceptable to treat smokers as bad people. They’re not…they’re human beings just like everyone else.
        Okay..I’m off my soap box for now…lol. Sorry for the rant, but I hope I gave people something to think about 🙂

        Liked by 1 person

        1. All good examples – but don’t get me wrong. As sad as the sight of that war vet smoking in the rain may be, the right of smokers to inflict their smoking effects on any other people ends with the right of others to breathe. That’s why we have designated hospital gazebos and smoking porches – yet at our hospital, I still see patients smoking while sitting on the entryway benches clearly marked NO SMOKING, thus impacting every other person nearby.

          This isn’t about being anti-smoking, it’s about consideration – and that has to go both ways.


          1. Absolutely…I agree 100%. We often see an extreme pendulum-shift when changing a major dynamic in our lives, and that holds true for the smoking/non-smoking issue. For generations, smokers lit up whenever and where ever..and this was socially acceptable. That didn’t make it right..just socially acceptable

            Now the pendulum has swung, and smokers are the new persona non-grata and are the focus of segregation, disrespect, intolerance, and outright abuse…and this is now socially acceptable. It doesn’t make it right..just socially acceptable.

            But what purpose does it serve? To change a major unhealthy dynamic in society…yes. But what of those already trapped in that dynamic? Sooner or later, society will realize that changes of this magnitude will come in stages, over generations. When it does, I believe the pendulum will have found its resting place, midway between the two extremes. Until then, we have a country that’s divided..with resentment on both sides..people lashing out at others, instead of looking for resolutions that benefit both…and there are absolutely ways in which resolutions can be reached, if we can just get past this witch-hunt and start looking at each other with compassion instead of condemnation.

            Liked by 1 person

  5. Well written. It’s astonishing to think we have all this knowledge and that we’re not using it. Makes you wonder exactly when we as patients will be expected to take responsibility for our own health choices, as opposed to expecting others to patch us up without us having to make any personal lifestyle changes. And what about hospital staff who are not taking aggressive pro-active steps to start stop-smoking programs while cardiac patients are under their complete control?

    I’ve subscribed your updates and will be checking back frequently.

    Liked by 1 person

  6. I was looking for articles on hypnosis to help quit smoking when I came across this excellent essay.

    I can’t understand why cardiac wards do not implement a simple hypnosis program before smoking heart patients are discharged home.

    Liked by 1 person

  7. I agree – I’m tired of smokers being the lepers of the 21st century. Smoking is a legal activity – my grandmother smoked 2 pks/day her whole life and died at age 92 after a bad fall NOT from her smoking.

    We’re all going to die of something some day, leave smokers alone.


  8. It’s unrealistic to suggest that somehow we can FORCE smokers to quit after a heart attack. It’s an addiction.

    Addicts know that their drug of choice is not “healthy” for them, but that doesn’t make it any easier for a smoker to quit because of a heart attack wake-up call than it is for a drug addict to quit just because he or she has had a close call with an overdose.

    You would THINK that both scenarios would absolutely convince a person to quit – but that is the power of addiction.

    Liked by 1 person

  9. Smoking is bad for health; to stop smoking properly you need discipline so your stop smoking programs can give results.


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