Background
Prioritizing and managing multiple behavior changes following a cardiac hospitalization can be difficult, particularly among smokers who must also overcome a serious addiction.
Hypothesis
Hospitalized smokers will report a strong interest in smoking cessation (SC) but will receive little assistance from their physicians.
Methods
We asked current smokers hospitalized for an acute cardiac event to prioritize their health behavior priorities, and inquired about their attitude toward SC therapies. We also assessed SC cessation prescriptions provided by their physicians.
Results
Of the 105 patients approached, 81 (77%) completed the survey. Of these, 72.5% ranked SC as their greatest health change priority, surpassing all other behavior changes, including: taking medications, attending cardiac rehabilitation (CR), dieting, losing weight, and attending doctor appointments. Patients felt that SCM (44%), CR (41%), and starting exercise (35%) would increase their likelihood for SC. While most patients agreed that smoking was harmful, 16% strongly disagreed that smoking was related to their hospitalization. At discharge, medication was prescribed to ~32% of patients, with equal frequency among patients who reported interest and those who reported no interest in using medications.
Conclusion
The majority of hospitalized smokers with cardiac disease want to quit smoking, desire help in doing so, and overwhelmingly rate cessation as their highest health behavior priority, although some believe smoking is unrelated to their disease. The period following an acute cardiac event appears to be a time of great receptivity to SC interventions; however, rates of providing tailored, evidence‐based interventions are disappointingly low.
Introduction: Limited data are available on the epidemiology and predictors of improvement or recovery of left ventricular ejection fraction (LVEF) in outpatients with heart failure (HF) and reduced (≤40%) LVEF (HFrEF). Also, data on the impact of LVEF improvement on outcomes in these patients are scarce. Hypothesis: We hypothesized that (1) clinical characteristics of outpatients with HFrEF can predict improvement of LVEF (to >40%) by 1 year and (2) LVEF improvement (to >40%) leads to lower risk for subsequent events (death and HF admissions). Methods: We evaluated 805 patients with HFrEF who received outpatient care from 01/01/12 to 03/ 31/12 (inception period) and extracted data on serial echocardiographic assessments, interim advanced HF therapies, and outcomes. To assess impact of LVEF trajectory on outcomes, we performed a landmark analysis at 1 year follow-up. Results: Among 724 patients who were alive at 1 year and had not received advanced HF therapies in the interim, 380 (52.5%) had repeat echocardiograms. Of those, 57/380 (15.0%) had improved LVEF to >40% (median change, +18%; 25th to 75th percentile, +10% to +25%), whereas 323 did not improve (0%; -5% to +5%). Table 1 presents the baseline characteristics according to 1-year LVEF change. Baseline LVEF ≥30% (odds ratio [OR] 5.06; 95%CI 2.62-9.77; P < .001), nonischemic HF (OR 2.11; 95%CI 1.11-4.02; P=.023), and absence of implantable cardioverter defibrillator (OR 3.37;; P=.009) predicted LVEF improvement to >40%. In a subset of 272 patients with data on HF duration, improvement was less likely with longer HF duration (OR per year 0.83; 95%CI 0.72-0.94; P=.005). In a landmark analysis at 1 year, 5/57 patients with improved LVEF died in the next 2 years vs. 55/323 among nonimprovers (2-year mortality: 10.1% vs. 17.1%, log-rank P=.13). Improvers had significantly lower rates of combined death or HF admission vs. non-improvers (Fig. 1), hazard ratio 0.37 (95%CI 0.20-0.70; P=.002) in adjusted models. Conclusions:In our chronic HFrEF cohort, 15% of patients improved their LVEF within 1 year. These patients experienced lower rates of combined mortality and HF admission in the next 2 years.
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