Assessment of smoking care by stroke specialists in patients with recent TIA and minor stroke: an international prospective registry-based cohort study

• Published in: BMJ open Vol. 14; no. 7; p. e078632
• Main Authors: Lavallee, Philippa, Charles, Hugo, Labreuche, Julien, Albers, Gregory W, Caplan, Louis, Donnan, Geoffrey A, Ferro, José Manuel, Hennerici, M G, Molina, Carlos A, Rothwell, Peter, Steg, Gabriel, Touboul, Pierre-Jean, Uchiyama, Shinichiro, Vicaut, Eric, Wong, Lawrence K S, Amarenco, Pierre
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 03.07.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult neurology; Aged; Alcohol abuse; Cardiovascular Disease; Cigarettes; Cohort analysis; Counseling; Drug therapy; Europe - epidemiology; Female; Humans; Ischemia; Ischemic Attack, Transient - epidemiology; Latin America - epidemiology; Male; Middle Aged; Missing data; Neurology; Patients; PREVENTIVE MEDICINE; Proportional Hazards Models; Prospective Studies; Registries; Regression analysis; Risk Factors; Smoking - epidemiology; Smoking cessation; Smoking Cessation - statistics & numerical data; Stroke; Stroke - epidemiology; Tobacco; Transient ischemic attack; Variables; Europe; Latin America; Adult neurology; Cardiovascular Disease; PREVENTIVE MEDICINE; Stroke; Risk Factors
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-078632

ObjectivesThe objectives are to assess smoking abstinence and its effects on vascular risk and to report tobacco-cessation counselling and pharmacotherapy use in patients who had a recent minor stroke or transient ischaemic attack (TIA).Design and settingThe TIA registry.org project is a prospective, observational registry of patients with TIA and minor stroke that occurred in the previous 7 days with a 5-year follow-up, involving 61 sites with stroke specialists in 21 countries (Europe, Asia, Latin America and Middle East). Of those, 42 sites had 5-year follow-up data on more than 50% of their patients and were included in the present study.ParticipantsFrom June 2009 through December 2011, 3847 patients were eligible for the study (80% of the initial cohort).OutcomesTobacco counselling and smoking-cessation pharmacotherapy use in smoking patients were reported at discharge. Association between 3-month smoking status and risk of a major cardiovascular event (MACE) was analysed with multivariable Cox regression model.ResultsAmong 3801 patients included, 835 (22%) were smokers. At discharge, only 35.2% have been advised to quit and 12.5% had smoking-cessation pharmacotherapy prescription. At 3 months, 383/835 (46.9%) baseline smokers were continuers. Living alone and alcohol abuse were associated with persistent smoking; high level of education, aphasia and dyslipidaemia with quitting. The adjusted HRs for MACE at 5 years were 1.13 (95% CI 0.90 to 1.43) in former smokers, 1.31 (95% CI 0.93 to 1.84) in quitters and 1.31 (95% CI 0.94 to 1.83) in continuers. Using time-varying analysis, current smoking at the time of MACE non-significantly increased the risk of MACE (HR 1.31 (95% CI 0.97 to 1.78); p=0.080).ConclusionIn the TIAregistry.org, smoking-cessation intervention was used in a minority of patients. Surprisingly, in this population in which, at 5 years, other vascular risk factors were well controlled and antithrombotic treatment maintained, smoking cessation non-significantly decreased the risk of MACE.