Integrated Smoking Cessation and Mood Management for ACS Patients

ACS 患者的综合戒烟和情绪管理

• 批准号: 9324458
• 负责人: Andrew M Busch
• 金额: $ 19.93万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-02 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9324458
• 关键词: Abstinence; Address; American Heart Association; Attention; Behavior Therapy; Behavioral; Blood Pressure; Cardiac; Cardiac health; Cessation of life; Coronary; Counseling; Depressed mood; Enrollment; Event; Feedback; Goals; Gold; Hospitalization; Hospitals; Individual; Intervention; Interview; Link; Major Depressive Disorder; Manuals; Mediating; Mediator of activation protein; Medical; Mental Depression; Moods; Morbidity - disease rate; Myocardial Infarction; Nurses; Outcome; Patients; Population; Post Technic; Prevalence; Public Health; Randomized; Recurrence; Relapse; Research; Risk Factors; Smoke; Smoker; Smoking; Smoking Status; Structure; Survival Rate; Survivors; Techniques; Testing; Time; Training; Treatment Efficacy; Unstable angina; Work; abstracting; acute coronary syndrome; base; collaborative care; depression prevention; depressive symptoms; design; efficacy testing; efficacy trial; exercise capacity; experience; follow-up; improved; inflammatory marker; mortality; nicotine patch; primary outcome; relapse patients; smoking cessation; theories; treatment effect

Project Summary/Abstract Approximately 420,000 smokers survive an Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. The occurrence of ACS can be conceptualized as a “teachable moment,” whereby patients may be more receptive to smoking cessation messages. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS hospitalization. Thus, a single, integrated treatment that targets both depressed mood and smoking could be highly effective in reducing post-ACS mortality. Behavioral Activation may be an ideal counseling treatment for this population because it is easy to train, can be delivered by nurse level practitioners, and has recently shown promise for enhancing cessation outcomes in smokers with depression. Through extensive pilot work we systematically developed a counseling intervention that integrates gold standard smoking cessation counseling with Behavioral Activation based mood management for post-ACS smokers; Behavioral Activation Treatment for Cardiac Smokers (BAT-CS). The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 306 smokers with ACS and randomizing them to 12 weeks of nurse delivered BAT-CS or control (including full attention match). Both groups will be offered the nicotine patch if medically cleared. Follow-up assessments will be conducted at end-of-treatment and 6, 9, and 12 months after hospital discharge. We will track the occurrence of major adverse cardiac events and all-cause mortality for 18-36 months post-discharge. The primary outcomes will be depressed mood and biochemically validated 7-day point prevalence abstinence. The specific aims of the study are: Aim I: Test the efficacy of BAT-CS vs. control on depressed mood and smoking cessation. Aim II: Test the efficacy of BAT-CS vs. control on cardiac health. Aim III: Explore hypothesized mediators of treatment effects. Aim IV: Explore the temporal interaction of smoking and multiple aspects of mood over 1 year post-ACS. The long-term goal of this line of research is to improve long-term survival rates following ACS.

项目概要/摘要 大约 420,000 名吸烟者在急性冠状动脉综合征（ACS；不稳定型心绞痛、ST 和 美国每年都会发生非 ST 段抬高型心肌梗死）。 ACS 的发生可以被概念化为 一个“教育时刻”，患者可能更容易接受戒烟信息。持续 ACS 后吸烟是死亡率的独立预测因素。 ACS 后抑郁情绪也是有预测性的 死亡率，情绪抑郁的吸烟者在 ACS 后戒烟的可能性较小 住院治疗。因此，针对抑郁情绪和吸烟的单一综合治疗可能是 对于降低 ACS 后死亡率非常有效。行为激活可能是一种理想的咨询治疗方法 这个人群因为很容易培训，可以由护士级别的从业人员提供，并且最近已经 有望提高抑郁症吸烟者的戒烟效果。通过广泛的试点工作 我们系统地开发了一种结合黄金标准戒烟的咨询干预措施 为 ACS 后吸烟者提供基于行为激活的情绪管理咨询；行为激活 心脏病吸烟者治疗 (BAT-CS)。当前研究的总体目标是进行全动力 疗效试验招募了 306 名患有 ACS 的吸烟者，并将他们随机分配到由护士提供 BAT-CS 或 控制（包括完全注意力匹配）。如果经过医学检查，两组都将获得尼古丁贴片。 随访评估将在治疗结束时以及出院后 6、9 和 12 个月进行 释放。我们将追踪18-36岁的主要不良心脏事件和全因死亡率的发生情况 出院后几个月。主要结果是抑郁情绪和 7 天的生化验证 点普遍禁欲。该研究的具体目标是： 目标 I：测试 BAT-CS 与对照的功效 关于抑郁情绪和戒烟。目标 II：测试 BAT-CS 与对照对心脏健康的功效。 目标 III：探索治疗效果的假设中介因素。目标 IV：探索时间相互作用 ACS 后 1 年内吸烟和情绪的多个方面。该研究方向的长期目标是 提高 ACS 后的长期生存率。