Background The EUROACTION plus study aimed to assess effectiveness of a nurse-led preventive cardiology programme for high CVD risk smokers willing to make a quit smoking attempt compared to usual care in general practice.
Methods High CVD risk smokers aged to 18–80 years with vascular disease and 50–80 years at high risk of developing CVD (Heartscore ≥5% over 10 years, or treated for risk factors or DM) and their partners were individually randomised to either the programme (EA+) or usual care (UC). EA+ patients had optional access to free varenicline and met with the study nurse every 2 weeks to support their quit attempt and to have dietary and physical activity advice and CVD risk factor management. The primary outcome was self reported 7-day point prevalence of abstinence validated with breath carbon monoxide of <10 ppm. Analysis was by intention to treat (ITT). Follow-up was at 16 weeks.
Results 696 patients were recruited: 350 randomised to EA+ and 346 to UC. 85% EA+ and 83% UC returned at 16 weeks. 91% of patients in EA+ chose to use varenicline to help them to quit smoking and 51% of EA+ patients quit compared to 19% in UC (OR 4.52 95% CI 3.2 to 6.4 p<0.0001). In those who fully participated in EA+ 63% quit smoking compared to 17% who did not complete and 22% who did not participate. At follow-up self reported health related quality of life (HRQoL) was better in EA+ with significantly higher mean EQ-VAS scores in EA+ (74/100) compared to UC (70, p=0.002). Functional limitation profile scores (SF36) improved in EA+ during the programme (25.6−26.2 ∆ +0.56 95% CI 0.23 to 0.88 p=0.0009). No differences were seen in depression scores (HADS), but anxiety scores reduced in EA+ during the programme (5.63−5.27 ∆ −0.35 95% CI −0.67 to −0.03 p=0.03).
Conclusion Intensive support from nurses with optional use of varenicline was successful in helping over half of all high CVD risk smokers to quit. This was associated with a reduction in anxiety and increased quality of life.
- Smoking cessation
- preventive cardiology