STRESS, SOCIAL SUPPORT, AND STOPPING SMOKING AFTER MYOCARDIAL-INFARCTION IN ENGLAND

Study objective - To examine the effect on mortality of stopping smoki ng after myocardial infarction and the psychosocial factors that influ ence the decision to stop. Design - Analysis of smokers in a large pro spective study. Self completed questionnaires provided information on psychosocial factors. Setting - Coronary care units at six English hos pitals participating in a multicentre clinical trial. Subjects - These comprised consenting myocardial infarction survivors who had been ide ntified as smokers and who completed questionnaires within seven days of infarct at six hospitals participating in the Anglo-Scandinavian st udy of early thrombolysis. The 532 patients identified have been follo wed for over five and a half years. The main outcome measure was five year all cause mortality. Main results - Smokers who stopped within on e month showed significantly reduced mortality compared with those who persisted, adjusting for other prognostic indicators (odds ratio 0.56 , 95% confidence interval 0.33, 0.98). Overall, 74% stopped smoking. B eing married, low life stress levels before infarct, and higher social class were associated with stopping smoking but the differentials wer e small. Of the clinical variables, a final diagnosis of definite myoc ardial infarction was associated with stopping smoking. All associatio ns remained after multiple logistic regression. Conclusions - Smoking cessation can halve the smokers' odds of dying after myocardial infarc tion and psychosocial factors play a small but important role in the i mportant decision to stop smoking. Health professionals should continu e to stress the importance of stopping smoking to all patients as ther e is Little evidence to support specific directing of advice to relati vely ''stressed or ''socially isolated'' groups.