Chronic stable angina treatment smoking cessation: Difference between revisions
No edit summary |
|||
| Line 8: | Line 8: | ||
==Smoking Cessation: The 5A Step-wise Strategy== | ==Smoking Cessation: The 5A Step-wise Strategy== | ||
*A: Ask | *A: Ask systematic identification of all smokers at every opportunity. | ||
*A: Assess | *A: Assess determine the patient’s degree of addiction and his/her willingness to stop smoking. | ||
*A: Advise | *A: Advise strongly encourage all smokers to quit smoking. | ||
*A: Assist | *A: Assist provide a smoking cessation strategy that includes behavioral counseling, nicotine replacement therapy and/or pharmacological intervention. | ||
*A: Arrange | *A: Arrange offer help to schedule follow-up visits. | ||
==Supportive Trial Data== | ==Supportive Trial Data== | ||
Revision as of 17:02, 31 January 2013
|
Chronic stable angina Microchapters | ||
|
Classification | ||
|---|---|---|
| ||
| ||
|
Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
|
Diagnosis | ||
|
Alternative Therapies for Refractory Angina | ||
|
Discharge Care | ||
|
Guidelines for Asymptomatic Patients | ||
|
Case Studies | ||
|
Chronic stable angina treatment smoking cessation On the Web | ||
|
Chronic stable angina treatment smoking cessation in the news | ||
|
to Hospitals Treating Chronic stable angina treatment smoking cessation | ||
|
Risk calculators and risk factors for Chronic stable angina treatment smoking cessation | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan. M.B.B.S.
Overview
The 1989 Surgeon General’s report, which assessed numerous case-control and cohort studies, reported that smoking increased cardiovascular disease mortality by 50%.[1] Cigarette smoking, likely due to the hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release, plays an important role in the pathogenesis of coronary artery disease. Cigarette smoking also forms a major risk factor for acute cardiovascular events as it relates to an associated increase in blood coagulability.[2] Hence, cigarette smoking is an important reversible risk factor in the pathogenesis of CAD and cessation of which improves prognosis and is associated with a substantial decrease in the risk of mortality.[3][4][5] In patients with stable angina pectoris, nicotine replacement therapy has shown to be potentially beneficial despite the associated cardiovascular risks of nicotine, such as increase in heart rate with a small rise in blood pressure. Nicotine replacement therapy may be initiated as early as 2–3 days after acute myocardial infarction or cardiac arrhythmias.[2] Additionally, nicotine patches have been used successfully in high-risk patients without any adverse effects such as aggravation of MI or arrhythmia.[6][7]
Smoking Cessation: The 5A Step-wise Strategy
- A: Ask systematic identification of all smokers at every opportunity.
- A: Assess determine the patient’s degree of addiction and his/her willingness to stop smoking.
- A: Advise strongly encourage all smokers to quit smoking.
- A: Assist provide a smoking cessation strategy that includes behavioral counseling, nicotine replacement therapy and/or pharmacological intervention.
- A: Arrange offer help to schedule follow-up visits.
Supportive Trial Data
- The Cochrane database, a meta-analysis of 20 studies that aimed to estimate the magnitude of risk reduction associated with smoking cessation, reported that there was a 36% reduction in the overall mortality (crude RR 0.64, 95% CI 0.58 to 0.71) and a significant reduction in the rate of non-fatal MI (crude RR 0.68, 95% CI 0.57 to 0.82).[5]
- Based on a placebo-controlled, randomized study that assessed the cardiovascular safety of nicotine patches in patients with coronary artery disease who tried to quit smoking, there were no observed changes in the resting heart rate and blood pressure between the screening and follow-up phases. There were also no significant changes observed in the number and duration of ischemic episodes or in the frequency of arrhythmias. However, exercise tolerance and time to 1-mm ST segment depression increased in both groups. Thus, the study concluded the use of nicotine patches to promote smoking cessation was safe in patients with high-risk for CAD.[6] Similar results were observed in another study that assessed the safety of transdermal nicotine for smoking cessation in patients with coronary artery disease.[7]
2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[8][9]
Smoking Cessation (DO NOT EDIT)[8][9]
| Class I |
| "1. Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home is recommended. Follow-up, referral to special programs, and/or pharmacotherapy (including nicotine replacement) is recommended, as is a stepwise strategy for smoking cessation (Ask, Advise, Assess, Assist, Arrange). (Level of Evidence: B) " |
References
- ↑ Centers for Disease Control (CDC) (1989) The Surgeon General's 1989 Report on Reducing the Health Consequences of Smoking: 25 Years of Progress. MMWR Morb Mortal Wkly Rep 38 Suppl 2 ():1-32. PMID: 2494426
- ↑ 2.0 2.1 Benowitz NL, Gourlay SG (1997) Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol 29 (7):1422-31. PMID: 9180099
- ↑ Bartecchi CE, MacKenzie TD, Schrier RW (1994) The human costs of tobacco use (1) N Engl J Med 330 (13):907-12. DOI:10.1056/NEJM199403313301307 PMID: 8114863
- ↑ MacKenzie TD, Bartecchi CE, Schrier RW (1994) The human costs of tobacco use (2) N Engl J Med 330 (14):975-80. DOI:10.1056/NEJM199404073301406 PMID: 8121461
- ↑ 5.0 5.1 Critchley J, Capewell S (2003) Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev (4):CD003041. DOI:10.1002/14651858.CD003041 PMID: 14583958
- ↑ 6.0 6.1 Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P (1998) Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking. Cardiovasc Drugs Ther 12 (3):239-44. PMID: 9784902
- ↑ 7.0 7.1 (1994) Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease. Arch Intern Med 154 (9):989-95. PMID: 8179456
- ↑ 8.0 8.1 Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[1] PMID: 17998462
- ↑ 9.0 9.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758