Smoking cessation after myocardial infarction: Findings from a cross-sectional survey in Armenia

Introduction: The effectiveness of smoking cessation in preventing myocardial infarction (MI) and reducing its recurrence, morbidity and mortality is well established. Only half of the patients quit or reduce smoking after hospitalization. The study examined smoking cessation practices and factors associated with it at 6-12 months after hospitalization among smoker patients diagnosed with MI.

Methods: A cross-sectional survey (2016-2017) was conducted among smoker adult patients who were diagnosed with MI and were hospitalized at the largest cardiac hospital (Nork-Marash Medical Center) in Armenia. Data collection was conducted via medical record review and an interviewer-administered telephone survey (n=230). The patients were classified as non-quitters or quitters (those had not smoked even a puff within the past 30 days). Multivariate logistic regression analysis was used to examine factors associated with smoking cessation at 6-12 months post-hospitalization addressing multicollinearity with two separate regression models.

Results: The mean age of participants was 58.3 years and 98.3% were males. Though almost all MI patients attempted to quit, only 52.2% were successful abstainers at 6-12 months after hospitalization. Significant predictors of quitting included higher self-efficacy (AOR=1.07; 95% CI: 1.03-1.11, p<0.001), lower tobacco dependence (AOR=0.81; 95% CI: 0.66-1.00, p=0.050), not having family members who smoked (Model 1: AOR=0.24; 95% CI: 0.08-0.70, p=0.009; and Model 2: AOR=0.24; 95% CI: 0.09-0.67, p=0.006), having other hospitalization after MI due to heart disease (Model 1: AOR=5.42; 95% CI: 1.50-19.65, p=0.010; and Model 2: AOR=4.20; 95% CI: 1.32-13.31, p=0.015), higher number of household members (Model 1: AOR=1.83; 95% CI: 1.27-2.64, p=0.001; and Model 2: AOR=1.68; 95% CI: 1.20-2.35, p=0.002), and having at least one comorbidity (Model 1: AOR=4.20; 95% CI: 1.47-12.04, p=0.008; and Model 2: AOR=3.74; 95% CI: 1.40-9.97; p=0.008).

Conclusions: The study emphasized the need for integrating evidence-based cessation services and targeted help for hospitalized MI patients in Armenia. Interventions should aim to improve self-efficacy, effectively treat dependence, and consider patients' social environment while providing cessation assistance.