Effect of Intensive Personalized “5As+5Rs” Intervention on Smoking Cessation in Hospitalized Acute Coronary Syndrome Patients Not Ready to Quit Immediately: A Randomized Controlled Trial

Abstract

Smoking has a major impact on acute stages of ACS for recurrent ischemic events and long-term outcomes. However, there are few evidence-based treatments for smokers who are not ready to quit. This study described a cessation intervention initiated during hospitalization and included 15 intensive follow-up aimed at enabling ACS smokers who were not ready to quit immediately to deliver adequate motivational and behavior change counseling. Given its effectiveness demonstrated in this prospective study, this intervention in hospitalized ACS smokers might have the potential to substantially improve the cessation rate of ACS patients who are not ready to quit smoking immediately.

The efficacy of smoking cessation interventions in low‐ and middle‐income countries: a systematic review and meta‐analysis

“…The studies included a total of 13 141 participants from 11 countries. Seven studies (29%) were carried out in China [27,29,35,36,38,44,45], three (13%) each in India [39,42,46], Brazil [30,32,40] and Iran [22,26,33], two (8%) each in Malaysia [28,31] and South Africa [24,37] and one (4%) each in Pakistan [41], Syria [43], Thailand [23] and Turkey [34]. Four studies recruited participants from the community, one from a prison, and the remaining 19 recruited participants from medical clinics.…”

“…A smaller number of studies (eight of 25; 32%) reported the method employed for allocation sequence concealment prior to participant enrollment, such as using sequentially numbered opaque envelopes [30,35,37,43,44], pulling numbers out of a box [45] or blinded treatment providers [38,40]. A smaller number of studies (eight of 25; 32%) reported the method employed for allocation sequence concealment prior to participant enrollment, such as using sequentially numbered opaque envelopes [30,35,37,43,44], pulling numbers out of a box [45] or blinded treatment providers [38,40].…”

“…Three studies did not use a placebo control when evaluating pharmacological interventions [25,33,41]. Ten studies (42%) failed to indicate whether their outcome assessors were blinded to study condition [25,29,[32][33][34]36,[39][40][41]45], four studies (17%) reported that their assessors were not blinded to study condition [27,30,37,42] and the remaining 10 studies (42%) reported using blinded assessors [23,24,26,28,31,35,38,43,44,46]. Ten studies (42%) failed to indicate whether their outcome assessors were blinded to study condition [25,29,[32][33][34]36,[39][40][41]45], four studies (17%) reported that their assessors were not blinded to study condition [27,30,37,42] and the remaining 10 studies (42%) reported using blinded assessors [23,24,26,28,…”

“…They reported that the additional telephone calls increased continuous abstinence at 6 months. Among patients with acute coronary syndrome, '5As + 5Rs' (5As = Ask, Advise, Assess, Assist, Arrange; 5Rs = Relevance, Risks, Rewards, Roadblocks and Repetition [47]) counseling was more effective than 5Rs alone in achieving continuous abstinence [38]. In Brazil, De Azevedo [30] found similar abstinence rates among participants randomized to receive either 30 minutes of counseling at baseline plus seven booster sessions via telephone or 15 minutes of counseling at baseline with no follow-up.…”

“…All the included studies were randomized, and the majority of studies (16 of 24; 67%) reported the method of random sequence generation for participant randomization. A smaller number of studies (eight of 25; 32%) reported the method employed for allocation sequence concealment prior to participant enrollment, such as using sequentially numbered opaque envelopes [30,35,37,43,44], pulling numbers out of a box [45] or blinded treatment providers [38,40]. Only one study [42] explicitly reported that allocation sequence was not concealed, as participant folders were flagged with colored stickers.…”