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Opening the window of opportunity: encouraging patients to stop smoking
  1. School of Community Medicine
  2. University of New South Wales
  3. Kensington NSW 2052, Australia.
  4. email:

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Smoking is a complex behaviour involving physiological dependence on regular administration of nicotine, psychological dependence to cope with stress, and reinforcement in social contexts. Smoking cessation is difficult.

Evidence for intervening with smokers

Physicians inform patients about the overwhelming evidence demonstrating the cardiovascular hazards of tobacco use and the health benefits from smoking cessation, but many continue to smoke. Smoking contributes to approximately 30% of all ischaemic heart disease deaths (IHD) in the USA each year, and the risk is strongly dose related.1 ,2 Smoking acts synergistically with other risk factors leading to an increased risk of IHD,3 as well as nearly doubling the risk of ischaemic stroke.4 At age 30–49 years the rates of myocardial infarction in smokers are five times those of non-smokers; at 50–59 they are three times those of non-smokers; and at 60–79 they are twice as great as for non-smokers.5 About half of those who smoke are killed by their habit, whereas among never and ex-smokers, 80% survive to 70 and 33% to 85 years old.6

An adverse cardiac condition or cardiac interventional procedure encourages smokers to quit their habit.7 ,8 Among patients with coronary artery disease, the likelihood of cessation from smoking increases with the severity of symptoms and signs of disease.9-11 Patients with unstable angina are more likely to quit smoking than those with stable angina.12The rate of smoking cessation in patients with angiographically confirmed coronary artery disease varies from 35% to 75%.9-11 ,13 Providing smoking cessation advice to patients who have been hospitalised with a coronary condition results in a 50% long term (more than one year) abstinence rate.7 ,14 Abstinence at one year is achieved in two thirds of smokers after percutaneous coronary revascularisation and advice from physicians using a comprehensive …

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