Volume 203 - Issue 2
Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome
Authors: Colin P Mendelsohn and Paul V Camp
Med J Aust 2015; 203 (2): 80. || doi: 10.5694/mja15.00242
Published online: 20 July 2015
Published online: 20 July 2015
Counselling and pharmacotherapy are more effective than unassisted cessation of smoking
To the Editor: We would like to comment on some important inaccuracies in Vickery and Thompson's article on general practitioner management of patients after an acute coronary syndrome.1
The authors state that unassisted cessation of smoking (quitting without professional support or pharmacotherapy) is the most effective method. In fact, it is the least successful method and produces quit rates of only 3%–5% at 6–12 months.2 In comparison, the quit rate from combined counselling and pharmacotherapy ranges from 22% to 32%, depending on the intensity of counselling provided.3
Although many smokers ultimately quit without help, it is usually after numerous failed attempts. Each year that smokers delay quitting after the age of 35 results in a 3-month reduction in life expectancy.4 It is therefore vital that smokers stop at the earliest possible opportunity and that every quit attempt has the best possible chance of success.
We advise doctors to follow the Australian5 and United States.3 smoking cessation guidelines, which recommend the use of pharmacotherapy and counselling for all nicotine-dependent smokers.
The authors have also misinterpreted the Cochrane review data for the efficacy of nicotine replacement therapy (NRT). They state that 50%–70% of people achieve abstinence with NRT. However, the absolute long-term quit rate is only 6%–12% more than for placebo.6 The confusion may have arisen because NRT increases the rate of quitting by about 50%–70% compared with placebo.
Competing interests
Colin Mendelsohn has received payments for teaching, consulting and conference expenses from Pfizer Australia, GlaxoSmithKline and Johnson & Johnson Pacific.
References
- Vickery A, Thompson PL. Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome. Med J Aust 2014; 201 (10 Suppl): S110-S114. OLE_LINK1
- Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004; 99: 29-38. 2
- Tobacco Use and Dependence Guideline Panel. Clinical practice guideline. Treating tobacco use and dependence: 2008 update. Rockville, Md: US Department of Health and Human Services, 2008. 3
- Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004; 328: 1519. lefthere
- Zwar N, Richmond R, Borland R, et al. Supporting smoking cessation: a guide for health professionals. Melbourne: Royal Australian College of General Practitioners, 2011. http://www.racgp.org.au/your-practice/guidelines/smoking-cessation (accessed Jun 2015).
- Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012; (11): CD000146. 6