Psychosocial interventions for smoking cessation in patients with coronary heart disease

 

Abstract

Background

Quitting smoking improves prognosis after a cardiac event, but many patients continue to smoke, and improved cessation aids are urgently required.

Objectives

To assess the effectiveness of psychosocial interventions such as behavioural therapeutic intervention, telephone support and self-help interventions in helping people with coronary heart disease (CHD) to quit smoking.

Search methods

The Cochrane Central Register of Controlled Trials (issue 2 2003), MEDLINE, EMBASE, PsycINFO and PSYNDEX were searched from the start of the database to August 2003. Results were supplemented by cross-checking references, and handsearches in selected journals and systematic reviews.

Selection criteria

Randomised controlled studies (RCTs) in patients with CHD with a minimum follow-up of 6 months. After initial selection of the studies three trials with methodological flaws (e.g. high drop out) were excluded.

Data collection and analysis

Abstinence rates were computed according to an intention to treat analysis if possible, or if not on follow-up results only.

Main results

We found 16 RCTs meeting inclusion criteria. Interventions consist of behavioural therapeutic approaches, telephone support and self-help material and were either focused on smoking cessation alone or addressed several risk factors. The trials mostly included older male patients with CHD, predominantly myocardial infarction. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.25 to 2.22), but substantial heterogeneity between trials. Studies with validated assessment of smoking status at follow-up had lower efficacy (OR 1.44, 95% CI 0.99 to 2.11) than non-validated trials (OR 1.92, 95% CI 1.26 to 2.93). Studies were clustered by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The ORs for different strategies were similar (behavioural therapies OR 1.69, 95% CI 1.33 to 2.14; telephone support OR 1.58, 95% CI 1.28 to 1.97; self-help OR 1.48, 95% CI 1.11 to 1.96). More intense interventions showed increased quit rates (OR 1.98, 95% CI 1.49 to 2.65) whereas brief interventions did not appear effective (OR 0.92, 95% CI 0.70 to 1.22). Two trials had longer term follow-up, and did not show any benefits after 5 years.

Authors' conclusions

Psychosocial smoking cessation interventions are effective in promoting abstinence at 1 year, provided they are of sufficient duration. Further studies, with longer follow-up, should compare different psychosocial intervention strategies, or the addition of a psychosocial intervention strategy to pharmacological therapy (e.g. nicotine replacement therapy) compared with pharmacological treatment alone.

 

Plain language summary

Psychosocial smoking cessation interventions such as behavioural counselling, telephone support and self-help interventions are effective in helping people with coronary heart disease stop smoking

Smoking is a risk factor for coronary heart disease and stopping smoking lowers that risk. Psychosocial smoking cessation interventions such as behavioural therapy, telephone support and self-help materials are effective in helping coronary heart disease patients to stop smoking, if they are provided for over 1month. We found evidence that psychosocial interventions increased quit rates after 6 months. Most trials used a mixture of different intervention strategies, therefore no single strategy showed superior efficacy.

 

摘要

背景

心理治療用於冠心症患者戒菸

戒菸改善心臟疾病發生後的預後，但許多患者繼續吸煙，改善戒菸的幫助是迫切需要的。

目標

評估心理社會介入治療的成效，包括行為治療的介入，電話支持和自我幫助的介入方式來幫助冠心病患者的戒菸。

搜尋策略

搜尋自2003年8月起之以下資料庫：The Cochrane Central Register of Controlled Trials (issue 2 2003)、MEDLINE、EMBASE、PsycINFO 及 PSYNDEX，透過交叉比對參考文獻、人工搜尋特定期刊與系統性回顧來補充結果。

選擇標準

隨機對照研究在冠心病患者後續最少追蹤6個月。在這研究中，經初步篩選，三個試驗因為方法上的瑕疵(例如高退出率)被排除在外。

資料收集與分析

可能的話，則用治療意向來計算戒斷率；若無，則僅以追蹤結果計算。

主要結論

我們發現， 16個隨機對照研究符合納入的標準。其中介入處置包括行為治療評估，電話支持和自我幫助教材，且這些研究不只是單單著重於戒菸，也強調各種風險因子。這些試驗大多是患有冠心病的男性老年人，且具有明顯的心肌梗塞。整體而言，介入處置在6到12個月之後，對於戒煙有正向效果(勝算比(OR)1.66, 95 ％的信賴區間(CI)1.25到2.22),但各個試驗之間有很多的異質性。但在之後的追蹤，對於抽煙狀態有有效的評估的研究(勝算比 1.44, 95%信賴區間0.99 to 2.11)，比起沒有有效評估的研究，有較低的成效(勝算比 1.92, 95％信賴區間1.26到2.93)。所有的研究依介入策略和介入的強度被分群。分群後可減少異質性，雖然許多試驗使用了不只一種介入處置。勝算比在不同的策略是相似的(行為療法勝算比1.69，95％信賴區間1.33至2.14);電話支持勝算比1.58 ， 95 ％信賴區間為1.28至1.97;自我幫助勝算比1.48 ， 95 ％信賴區間為1.11至1.96) 。更積極的介入處置顯示，增加戒煙率(勝算比 1.98 ， 95 ％信賴區間為1.49至2.65)，然而短暫的介入處置似乎沒有成效(勝算比0.92 ， 95 ％ 信賴區間為0.70至1.22) 。有兩個研究做了長時間的追蹤，顯示這些介入性處置在五年後並沒有任何好處。

作者結論

心理社會的戒菸介入處置在1年的時候，可以有效的幫助抽菸者戒煙，並提供他們足夠的持續時間。進一步比較不同的心理社會介入處置的策略，或合併一個心理社會介入處置策略與藥物治療(如尼古丁替代療法)和單單只是用藥物治療相比較，做較長時間的追蹤。

翻譯人

本摘要由臺北榮民總醫院陳三奇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

心理社會戒菸的介入，例如行為輔導，電話支持和自我幫助的介入，在幫助有冠心病病人的戒煙是有效的。吸煙對冠心症病人是一個危險因子，且戒菸可以降低此風險。心理社會戒菸的介入，例如行為輔導，電話支持和自我幫助的干預，如果能提供超過一個月的話,在幫助有冠心病病人的戒煙是有效的。我們發現的證據顯示，心理社會的介入在6個月後可以增加戒煙率。大部份的研究使用綜合性不同的心理社會介入性方法，所以沒有一個單獨的方法顯現出較佳的效果。