Psychosocial smoking cessation interventions such as behavioural counselling, telephone support and self-help interventions are effective in helping people with coronary heart disease stop smoking

Barth J, Critchley JA, Bengel J

Published Online:

January 21, 2009

Smoking is a risk factor for coronary heart disease and stopping smoking lowers that risk. Psychosocial smoking cessation interventions such as behavioural therapy, telephone support and self-help materials are effective in helping coronary heart disease patients to stop smoking, if they are provided for over 1month. We found evidence that psychosocial interventions increased quit rates after 6 months. Most trials used a mixture of different intervention strategies, therefore no single strategy showed superior efficacy.

Abstract (click to read)

Background:

Quitting smoking improves prognosis after a cardiac event, but many patients continue to smoke, and improved cessation aids are urgently required.

Objectives:

To assess the effectiveness of psychosocial interventions such as behavioural therapeutic intervention, telephone support and self-help interventions in helping people with coronary heart disease (CHD) to quit smoking.

Search strategy:

The Cochrane Central Register of Controlled Trials (issue 2 2003), MEDLINE, EMBASE, PsycINFO and PSYNDEX were searched from the start of the database to August 2003. Results were supplemented by cross-checking references, and handsearches in selected journals and systematic reviews.

Selection criteria:

Randomised controlled studies (RCTs) in patients with CHD with a minimum follow-up of 6 months. After initial selection of the studies three trials with methodological flaws (e.g. high drop out) were excluded.

Data collection and analysis:

Abstinence rates were computed according to an intention to treat analysis if possible, or if not on follow-up results only.

Main results:

We found 16 RCTs meeting inclusion criteria. Interventions consist of behavioural therapeutic approaches, telephone support and self-help material and were either focused on smoking cessation alone or addressed several risk factors. The trials mostly included older male patients with CHD, predominantly myocardial infarction. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.25 to 2.22), but substantial heterogeneity between trials. Studies with validated assessment of smoking status at follow-up had lower efficacy (OR 1.44, 95% CI 0.99 to 2.11) than non-validated trials (OR 1.92, 95% CI 1.26 to 2.93). Studies were clustered by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The ORs for different strategies were similar (behavioural therapies OR 1.69, 95% CI 1.33 to 2.14; telephone support OR 1.58, 95% CI 1.28 to 1.97; self-help OR 1.48, 95% CI 1.11 to 1.96). More intense interventions showed increased quit rates (OR 1.98, 95% CI 1.49 to 2.65) whereas brief interventions did not appear effective (OR 0.92, 95% CI 0.70 to 1.22). Two trials had longer term follow-up, and did not show any benefits after 5 years.

Authors' conclusions:

Psychosocial smoking cessation interventions are effective in promoting abstinence at 1 year, provided they are of sufficient duration. Further studies, with longer follow-up, should compare different psychosocial intervention strategies, or the addition of a psychosocial intervention strategy to pharmacological therapy (e.g. nicotine replacement therapy) compared with pharmacological treatment alone.

This record should be cited as:

Barth J, Critchley JA, Bengel J. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006886. DOI: 10.1002/14651858.CD006886

Assessed as up to date:

October 3, 2007

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Primary Review Group:

Heart Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are psychosocial interventions in helping people with coronary heart disease (CHD) to quit smoking?

Bottom line:

Psychosocial (behavioural) smoking cessation interventions are effective in promoting abstinence at 6 to 12 months, provided they are of sufficient duration, ie, more than 1 month (median NNT*4, range 3–6). Brief interventions without some follow-up contact were not effective. Most trials used a mixture of different intervention strategies, therefore, no single strategy showed superior efficacy. *NNT = number needed to treat to benefit 1 individual.

Caveat:

The validation of smoking status was not a standard procedure in the trials, with only 7 trials describing any measure of biochemical validation. There were no studies comparing psychosocial interventions with pharmacological therapy (eg, nicotine replacement therapy) or with pharmacological therapy plus psychosocial interventions.

Context:

Smoking is a major risk factor for CHD, and stopping smoking lowers that risk. Psychosocial interventions that can assist quitting and promote abstinence include behavioural counselling, telephone support and self-help interventions.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Heart & circulation > Heart disease prevention > Lifestyle

Tobacco, drugs, & alcohol dependence > Tobacco > Interventions in specific groups

Cochrane group topics:

Heart > Other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Psychosocial smoking cessation interventions such as behavioural counselling, telephone support and self-help interventions are effective in helping people with coronary heart disease stop smoking

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