A total of 696 patients, 137 with vascular disease and 559 at high risk of developing cardiovascular disease, were randomized with their informed consent by the end of recruitment on March 31, 2011. A total of 350 were assigned to the intervention arm (EA+) and 346 to the usual care (UC) arm; 109 partners were also recruited. A 16-week follow-up was completed on July 31, 2011, in 299 patients (85.4%) in EA+ and 288 patients (83.2%) in UC.
For the primary end point—smoking abstinence for the last seven days confirmed with breath carbon monoxide less than 10 parts per million—51.2% of patients in the EA+ program were abstinent, compared with 18.8% in UC at 16 weeks, a highly statistically significant result (odds ratio, 4.52). In those partners who also smoked at the time of recruitment, 73.1% were abstinent in the EA+ arm, compared with 36.7% in UC, also highly statistically significant (odds ratio, 4.67).
Dietary and physical activity habits were also improved by the program: 52.3% of patients in EA+ achieved a Mediterranean diet score of 9 or greater, compared with 37.3% in UC; 16.2% in EA+ achieved the physical activity target, compared with 7.2% in UC with corresponding fitness improvement as demonstrated by a higher proportion achieving the METSmax target (Chester Step test): 37.8% in EA+ versus 27.3% in UC.
The program may also have limited weight gain normally associated with smoking cessation, as there were no significant differences in body weight between EA+ and UC at the 16-week follow-up.
Blood pressure management was improved in the EA+ group, compared with UC. According to the investigators, 52.4% achieved the target (140/90 mm Hg in patients and high risk of developing cardiovascular disease or 130/80 mm Hg in vascular patients or those with diabetes), compared with 42.9%% UC; but there were no differences in lipid or glucose levels. Better blood pressure control was achieved without the use of additional antihypertensive drug therapies, as prescribing of cardioprotective drugs was similar in both arms of the trial. Quality of life measured according to the EQ-VAS instrument was significantly higher in EA+ patients compared with UC patients.
“Nurses have demonstrated that they can coordinate a complex intervention and reduce total cardiovascular risk in a particularly challenging group—high cardiovascular disease risk smokers,” the researchers said. “The original EUROACTION study in general practice showed no effect on smoking. Now nurses have demonstrated that with the help of effective pharmacotherapy, varenicline, we can achieve real gains in smoking cessation in dependent high cardiovascular disease risk smokers.”
“Partners of patients who were also smoking had a much higher success rate in stopping smoking in this family-based program, compared with the partners of patients who had no access to specialist support. In addition, the partner’s efforts to stop smoking may have also contributed to the better result seen in patients.”
“The nurse-led EUROACTION preventive cardiology model has successfully demonstrated that it is possible to help persistent smokers to stop, and as importantly to reduce their total cardiovascular risk by achieving a healthier lifestyle and more effective risk factor management. Just addressing smoking cessation alone is not enough. We need a more comprehensive, family-based approach that addresses all risk factors.”