77 Enhancing secondary prevention: an audit of smoking cessation advice in stemi patients and post-discharge outcomes

Abstract Introduction Cardiovascular disease is a leading cause of morbidity and mortality worldwide (1), with ST elevation myocardial infarction (STEMI) being a significant contributor. Smoking is one of the most important modifiable risk factors for myocardial infarctions.(2,3) There is well established association between smoking and adverse cardiovascular outcomes, therefore requiring comprehensive attention in secondary prevention strategies.(4) We aim to evaluate the provision of smoking cessation advice to STEMI patients during their hospitalisation and assess the smoking cessation rates during post discharge follow up. The study seeks to bridge the gap between recommended guidelines for secondary prevention and the practical delivery of smoking cessation interventions in the acute setting. Methods We used the British Cardiovascular Intervention Society (BCIS) database to conduct a retrospective analysis spanning 15 months of admissions (from 1st October 2023 to 1st Jan 2024) with STEMI where patients identified as smokers. Admission records corresponding to the identified STEMI episodes were reviewed for evidence of smoking cessation advice. Parameters included documented discussions by the medical team and the cardiac rehabilitation team. These patients then had their clinical follow up letters scrutinised to ascertain their smoking status. Results Out of a total of 285 patients, 75 patients (26.3%) were identified as smokers. 71 patients (94.6%) were given smoking cessation advice. 38 (50.6%) patients were advised by both the medical team and the cardiac rehab team. 26 (34.6%) patients continued to smoke at clinic follow up. 2 patients were out of hospital cardiac arrest (OOHCA) and died before gaining consciousness. Conclusion Majority of the patients received smoking cessation advice and at least half benefited from advice by both the medical team and the cardiac rehabilitation team. Despite these positive aspects, a third of the patients continued to smoke at clinic follow up. This audit highlights the persistent challenge in achieving behavioural change and to consider strategies to discourage post discharge smoking behaviour. By incorporating multifaceted approach, healthcare providers can optimise smoking cessation efforts and contribute to improved long term cardiovascular outcomes in patients. Recommendations We recommend implementation of the following strategies in patients who are willing to engage. Offering counselling and cognitive behaviour therapy. Offering pharmacotherapy such as nicotine replacement therapy in collaboration with health care providers. Telehealth services for ongoing support. Facilitation of peer support groups and family involvement. Financial incentives to motivate and reward smoking cessation. Continuous quality improvement to regularly evaluate smoking cessation interventions. Conflict of Interest None