PREDICTORS OF SMOKING CESSATION AFTER CORONARY-ARTERY BYPASS GRAFT-SURGERY - RESULTS OF A RANDOMIZED TRIAL WITH 5-YEAR FOLLOW-UP

Objective: To test the efficacy of a smoking cessation program for inp atients recovering from coronary artery bypass graft surgery and to id entify predictors of cessation. Design: Randomized, controlled clinica l trial. Setting: Postoperative cardiac surgery unit of a large teachi ng hospital. Patients: Patients scheduled for coronary artery bypass s urgery by participating surgeons between 1 July 1986 and 1 July 1987 w ho had smoked 1 or more packs of cigarettes in the 6 months before adm ission. Of 120 eligible patients, 93 enrolled and 87 were discharged a live. All survivors were followed for at least 1 year; 94% were follow ed for a median of 5.5 years. Intervention: A three-session, nurse-del ivered behavior modification program using a videotape and face-to-fac e counseling was compared to usual care. Measurements: Smoking status was assessed six times in the year after surgery and 5.5 years after s urgery. Self-reported nonsmoking was validated by saliva cotinine assa y 1 and 5.5 years after surgery. Results: No statistically significant differences were found between control (n = 43) and intervention (n = 44) groups at baseline. One and 5.5 years after hospital discharge, v alidated continuous nonsmoking rates were identical in intervention an d control groups (51% at 1 year; 44% at 5.5 years). Multiple logistic regression identified four factors that were independently associated with nonsmoking for 1 year: fewer than 3 previous attempts to quit (od ds ratio, 7.4; 95% Cl, 1.9 to 29.1); more than 1 week of preoperative nonsmoking (odds ratio, 10.0; Cl, 2.0 to 50.2); definite intention to quit smoking (odds ratio, 12.0; Cl, 2.6 to 55.1); and no difficulty no t smoking in the hospital (odds ratio, 9.6; Cl, 1.8 to 52.2). Nonsmoki ng for 5.5 years was independently associated with two of these factor s: fewer than three previous attempts to quit and intention to quit sm oking after surgery. Cessation was not related to demographic factors, daily cigarette consumption, disease severity, hospital course, socia l support, or beliefs and attitudes. Conclusions: Even without specifi c intervention, nearly one half of smokers quit for 5 years after coro nary artery bypass surgery. A short inpatient education program did no t increase this rate. Future efforts should target the time after disc harge and focus on increasing motivation in patients who have repeated ly failed to quit.