Secondary Prevention Following Acute Coronary Syndrome Using Integrated Smoking Cessation and Mood Management

使用综合戒烟和情绪管理进行急性冠脉综合征的二级预防

• 批准号: 9284290
• 负责人: Andrew M Busch
• 金额: $ 47.5万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-18 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284290
• 关键词: Abstinence; Address; American Heart Association; Attention; Bachelor' s Degree; Behavioral; Biochemical; Blood Pressure; Cardiac; Cardiac health; Cessation of life; Coronary; Counseling; Depressed mood; Effectiveness; Enrollment; Event; General Population; Goals; Gold; Hospitalization; Hospitals; Individual; Intervention; Interview; Length of Stay; Logistics; Major Depressive Disorder; Mediating; Mediator of activation protein; Medical; Mental Depression; Moods; Morbidity - disease rate; Myocardial Infarction; Outcome; Patients; Population; Post Technic; Prevalence; Public Health; Randomized; Recurrence; Relapse; Research; Risk Factors; Secondary Prevention; Series; Site; Smoke; Smoker; Smoking; Smoking Status; Structure; Survival Rate; Survivors; System; Techniques; Testing; Time; Training; Treatment Efficacy; Unstable angina; Withholding Treatment; Work; acute coronary syndrome; base; collaborative care; cost effectiveness; depression prevention; depressive symptoms; design; efficacy testing; efficacy trial; experience; follow up assessment; follow-up; improved; inflammatory marker; innovation; mortality; nicotine patch; non-smoker; primary outcome; relapse patients; smoking cessation; subclinical depression; theories; treatment effect

Project Summary/Abstract Approximately 400,000 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 Bachelor's degree 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 324 smokers with ACS and randomizing them to 12 weeks of 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.

项目摘要/摘要 大约有40万吸烟者在急性冠状动脉综合征（ACS；不稳定的心绞痛，ST和 在美国，每年非ST高程心肌梗塞）。 ACS的发生可以被概念化为 一个“可教的时刻”，患者可能会更容易接受戒烟信息。持续 在ACS之后吸烟是死亡率的独立预测指标。 ACS后情绪低落也是预测的 死亡率和情绪低落的吸烟者不太可能在ACS之后戒烟 住院。那是一种针对拒绝情绪和吸烟的单一综合治疗方法 在降低ACS后死亡率方面非常有效。行为激活可能是理想的咨询疗法 该人口是因为它很容易训练，可以由学士学位级别的从业者提供 最近显示出有望增加抑郁症吸烟者停止结果。通过广泛 飞行员工作我们系统地开发了咨询干预措施，该干预措施整合了黄金标准吸烟 对ACS吸烟者的基于行为激活的情绪管理的停止咨询；行为 心脏吸烟者的激活处理（BAT-CS）。当前研究的总体目的是完全进行 有能力的效率试验招募了324名吸烟者，并将其随机招募到12周的BAT-CS或 控制（包括完全注意匹配）。如果医学上清除，则两组将提供尼古丁补丁。 随访评估将在治疗结束时进行，医院后6、9和12个月进行 释放。我们将跟踪18-36的重大不良心脏事件和全因死亡率的发生 入院后几个月。主要结果将是沮丧的情绪和生化验证的7天 点的禁欲。该研究的具体目的是：目标I：测试BAT-CS与控制的效率 情绪低落和戒烟。 AIM II：测试BAT-CS与控制心脏健康的效率。 AIM III：探索假设的治疗效应介体。 AIM IV：探索暂时的互动 吸烟和情绪多个方面在AC后1年。这一研究的长期目标是 提高AC后的长期存活率。