People who never smoked or quit smoking after undergoing balloon angioplasty and other procedures to open obstructed heart arteries had substantially greater improvements in health-related quality of life both six months and one year later compared to people who continued to smoke, according to researchers at Beth Israel Deaconess Medical Center in Boston.
"We all know that smoking is bad in many ways, but it's never too late to quit," says David Cohen, M.D., M.Sc., associate director of interventional cardiology at Beth Israel Deaconess. "Our study shows that continuing to smoke limits the major benefit of angioplasty and other coronary interventions, which are life-saving in some cases, but are generally performed to relieve chest pain and improve quality of life. This provides further motivation for physicians to recommend specific smoking cessation interventions, including drug treatment or formal smoking cessation programs, to coronary patients."
The report is published in the Sept. 19 issue of Circulation: Journal of the American Heart Association. It is believed to be the first report to document diminished quality of life by continued smoking after a medical procedure.
Cohen and his colleagues reanalyzed quality-of-life data from 1,432 people in two medical device clinical trials designed and managed by a not-for-profit clinical trial research organization at Beth Israel Deaconess. The earlier randomized trials led to the FDA approval of the first of a new generation of stents designed to keep arteries open longer and also demonstrated the long-term benefits of directional atherectomy, a procedure to remove atherosclerotic plaque from clogged arteries. Patients in the trials had undergone traditional balloon angioplasty, angioplasty with two kinds of stents, or directional atherectomy.
Although smokers also benefited from the procedures, they scored lower than both non-smokers and quitters across a broad range of physical and mental health measures as reported in self-assessment forms. The 4- to 7-point differences on the scales used translates to a noticeable impact on the quality of life, Cohen says, such as feeling less comfortable in physical activities, having more pain, or not doing all the things a person wants to be able to do in their lives.
More than 500,000 artery-clearing coronary interventions are performed annually in this country at a cost of more than $5 billion, Cohen says. About 25 percent of the patients are smokers.
Cohen is also an assistant professor of health policy and management at the Harvard School of Public Health and an assistant professor of medicine at Harvard Medical School. Funding for the study came from the American Heart Association and Guidant, a medical device company.
Beth Israel Deaconess Medical Center is a major patient care, research and teaching affiliate of Harvard Medical School and a founding member of CareGroup Healthcare System. BIDMC is the third largest recipient of National Institutes of Health research funding among independent U.S. teaching hospitals.
Media contacts:
David Van Dam, Beth Israel Deaconess communications
617-975-6135, dvandam@caregroup.harvard.edu
or Carol Cruzan Morton, Beth Israel Deaconess communications
617-975-6150, cmorton@caregroup.harvard.edu