Smoking behavior in men hospitalized with cardiovascular disease in Korea: a cross-sectional descriptive study.

OBJECTIVE: Korean men have the highest rate of smoking in the world, and cardiovascular disease (CVD) is the second leading cause of death in this population. The study's objective was to describe factors related to smoking behavior in men hospitalized with CVD in Korea. METHODS: In collecting data for this cross-sectional study, a structured questionnaire was administered using a guided interview and medical record abstraction. RESULTS: The study sample included 97 men with a mean age of 54.1 (+/-9.6) years. Most of the men were married (85.6%) and employed (79.4%), and had graduated from high school or higher levels of education (74.2%). Sixty-five percent of the men were addicted to nicotine. Lower education (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.01-10.14), starting to smoke at an early age (OR: 3.30, 95% CI: 1.14-9.50), and smoking more cigarettes per day (OR: 9.71, 95% CI: 2.31-40.90) were statistically significant independent predictors of their level of addiction. Twenty-two percent of the men smoked during their hospitalization, a behavior that was significantly associated only with their intention to quit smoking (OR: .09, 95% CI: .03-.31). CONCLUSION: This was the first study to investigate smoking behavior in men hospitalized with CVD in Korea. Its findings strongly suggest that smoking-cessation intervention is needed in this population and that Korean health care providers must be properly educated and trained to provide this service.

Impact of nesiritide on renal function in patients with acute decompensated heart failure and pre-existing renal dysfunction a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVES: Our purpose was to evaluate the impact of nesiritide on renal function in patients with acute decompensated heart failure and baseline renal dysfunction. BACKGROUND: Although nesiritide is approved for the treatment of acute decompensated heart failure, retrospective analyses have raised concerns that it may cause worsened renal function. To date, no randomized clinical trials have prospectively evaluated this issue. METHODS: Consecutive patients with acute decompensated heart failure and baseline renal dysfunction were enrolled in this randomized, double-blind, placebo-controlled clinical trial. Subjects were randomized to receive nesiritide (0.01 microg/kg/min with or without a 2-microg/kg bolus) or placebo (5% dextrose in water) for 48 h in addition to their usual care. Predefined primary end points of the trial were a rise in serum creatinine by > or =20% and change in serum creatinine. RESULTS: Seventy-five patients were enrolled (39 nesiritide, 36 placebo). The groups had similar baseline age (74.9 vs. 75.5 years, respectively), blood pressure (123/64 vs. 125/64 mm Hg) and serum creatinine (1.82 vs. 1.86 mg/dl). There were no significant differences in the incidence of a 20% creatinine rise (23% vs. 25%) or in the change in serum creatinine (-0.05 vs. +0.05 mg/dl). There were no significant differences in the secondary end points of change in weight (-2.19 vs. -1.58 kg), intravenous furosemide (125 vs. 107 mg), discontinuation of the infusion due to hypotension (13% vs. 6%), or 30-day death/hospital readmission (33% vs. 25%). CONCLUSIONS: In this randomized, double-blind, placebo-controlled clinical trial, nesiritide had no impact on renal function in patients with acute decompensated heart failure. (BNP-CARDS trial; http://www.clinicaltrials.gov/ct/show/NCT00186329?order=1; NCT00186329).

Beliefs about health, smoking, and future smoking cessation among South Korean men hospitalized for cardiovascular disease.

BACKGROUND: A particularly high rate of smoking among South Korean men corresponds to high rates of cardiovascular disease. OBJECTIVES: This study evaluated South Korean men hospitalized with cardiovascular disease to explore beliefs about the health benefits of smoking cessation, to determine smoking cessation intentions, and to identify factors associated with confidence in quitting smoking. METHODS: This was a cross-sectional, descriptive study. RESULTS: Of the study's 97 participants, only 78% believed that smoking cessation avoids or decreases the chance of developing heart disease; 93% reported their intention to quit; 74% had moderate to high confidence about quitting within the month after hospital discharge; and 88% preferred to quit by themselves without help. Significant predictors of low confidence in quitting were being married (odds ratio: 5.54, 95% confidence interval: 1.33-23.08); being alcohol dependent (odds ratio: 3.25, confidence interval: 1.20-8.80); and starting to smoke at or before 20 years of age (odds ratio: 2.96, confidence interval: 1.14-7.68). CONCLUSION: The study's participants were motivated to quit smoking for their health, but they must be educated to understand that smoking is addictive and that special intervention is needed.

Multifactor cardiovascular disease risk reduction in medically underserved, high-risk patients.

Few data exist on the effectiveness of cardiovascular disease (CVD) risk-reduction programs in patients with limited access to health care. The objective of this project was to evaluate a disease management approach to multifactor CVD risk reduction in patients with limited or no health insurance and low family income. Patients (n = 148) were recruited from not-for-profit or free clinics and hospitals and randomized to usual care or usual care plus team case management. Mean age was 59.3 years, 57% were women, 50% had less than a high school education, 57% were Hispanic, and 64% had no health insurance. All had > or =1 increased risk factor for CVD, and 24.5% had documented coronary artery disease. Follow-up measurements were obtained at 6 and 12 months. Primary outcomes were low-density lipoprotein cholesterol and systolic blood pressure. The disease management program was supervised by a physician, delivered by nurses and dietitians, and included comprehensive lifestyle changes and medications. Data were collected on 91% of patients at 12 months. Disease management produced clinically important decreases in selected risk factors compared with usual care, including systolic blood pressure (p <0.01) and low-density lipoprotein cholesterol (p <0.03). More patients with disease management than those with usual care moved from "high" and "very-high" risk to lower risk categories for selected risk factors. In conclusion, the disease management program had excellent retention and lower CVD risk factors and demonstrated the potential of such approaches for decreasing long-term disease burden in selected medically underserved populations.

Women's initiative for non-smoking (WINS) VI: reliability and validity of health and psychosocial measures in women smokers with cardiovascular disease.

PURPOSE: We present psychometric properties of 9 health and psychosocial measures in a sample of hospitalized women with cardiovascular disease. This information will be useful to others needing to make choices about selection of health and psychosocial measurements in women smokers. METHODS: Psychometric properties were examined using baseline measures from a cross-sectional study, nested within a randomized clinic trial, Women's Initiative for Non-Smoking. Women smokers hospitalized with cardiovascular disease were recruited from 10 hospitals in the San Francisco Bay Area. Measures included the perceived stress scale, a depression screener, self-efficacy, the sense of mastery scale, and measures of health-related quality of life from the Medical Outcomes Study. RESULTS: The sample of 277 women smokers ranged in age from 34 to 86 years (mean = 61 +/- 10.1). Studies of variability, including floor/ceiling effects, skewness, range, mean, and SD, indicated that most measures had sufficient variability to be predictive and detect both positive and negative changes over time. Internal-consistency reliabilities ranged from 0.63 to 0.86. Preliminary evidence of construct validity was found, with most hypotheses being confirmed. CONCLUSIONS: The battery of tests included in the Women's Initiative for Non-Smoking trial may be useful in identifying women at high risk of relapse and in detecting short-term quality-of-life outcomes. The measures generally performed well and show promise for advancing our understanding of the process of successful smoking cessation in this population. SUMMARY: Psychometric properties of the perceived stress scale, a depression screener, self-efficacy for quitting smoking, the sense of mastery scale, and measures of health-related quality of life from the Medical Outcomes Study in 277 women smokers hospitalized with cardiovascular disease were examined. The measures generally performed well and show promise for advancing our understanding of smokers in this population.

High rates of sustained smoking cessation in women hospitalized with cardiovascular disease: the Women's Initiative for Nonsmoking (WINS).

BACKGROUND: Although men hospitalized with cardiovascular disease (CVD) show high smoking-cessation rates, similar data for women are lacking. We tested the efficacy of smoking-cessation intervention in women hospitalized for CVD. METHODS AND RESULTS: In this randomized controlled trial conducted from 1996 to 2001, 277 women diagnosed with CVD (mean age 61+/-10 years) were randomly assigned within 1 of 12 San Francisco Bay Area hospitals to a usual-care group (UG; n=135) or intervention group (IG; n=142). Baseline histories were obtained, and interviews to ascertain self-reported smoking status occurred at 6, 12, 24, and 30 months after hospitalization. The UG received strong physician's advice, a self-help pamphlet, and a list of community resources. The IG received strong physician's advice and a nurse-managed cognitive behavioral relapse-prevention intervention at bedside, with telephone contact at intervals after discharge. The groups were similar demographically and had smoked cigarettes for a median of 38 (IG) or 40 (UG) years. Time to resumption of continuous smoking was assessed by Kaplan-Meier analysis, and risk differences between groups were determined. Time smoke-free was significantly greater for the IG than the UG (P=0.038). Point prevalence for nonsmoking at the interviews was somewhat greater for the IG than the UG (P>0.15 at all times). CONCLUSIONS: Cognitive behavioral intervention resulted in longer average times to resumption of smoking, but in these 2 groups of older women with limited social and financial resources, long-term success rates were similar. Systematic identification of smokers and even the brief intervention afforded the UG yielded a high smoking-cessation rate over time.

Women's initiative for nonsmoking (WINS) IV: description of 277 women smokers hospitalized with cardiovascular disease.

OBJECTIVES: This article describes the demographic, psychosocial, and medical characteristics and smoking patterns of women hospitalized with cardiovascular disease (CVD) enrolled in the Women's Initiative for Nonsmoking (WINS) trial. DESIGN: Study design is a randomized clinical trial with cross-sectional baseline data. SETTING: Women enrolled during a 27-month period from 10 hospitals in the San Francisco Bay Area. PARTICIPANTS: Subjects included 277 women. RESULTS: The women's ages ranged from 33 to 86 years, with a mean age of 60.7 (+/-10) years. Most (51%) were college graduates, had attended some college or had postgraduate degrees; 40% were married; 76% were white. Median income was between 30,000 dollars and 35,000, but 27% of the women had incomes less than 15,000 dollars per year. The women smoked a median of 20 cigarettes per day (range, 1-90). Median age when women began smoking was 18.6 years; average number of years smoked was 40; and 78% had made more than 2 previous attempts to quit. On a 10-point scale, 71% of the women rated their confidence to quit smoking (self-efficacy) as 5 or greater. According to the Burnam Depression Screener, 56.7% were depressed. CONCLUSIONS: This is the largest study describing the smoking patterns of women hospitalized with CVD. These women were older, white, had smoked for many years, were moderately to highly addicted to tobacco, had few financial resources, and a large proportion were depressed. These important psychosocial factors need to be taken into account when planning smoking cessation interventions for women with CVD.