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

项目总结/摘要 大约40万吸烟者在急性冠状动脉综合征（ACS;不稳定型心绞痛，ST和ST段抬高）中存活。 非ST段抬高型心肌梗死）。ACS的发生可以被概念化为 一个"教育的时刻，"借此病人可能更容易接受戒烟的信息。继续 ACS后吸烟是死亡率的独立预测因子。ACS后抑郁情绪也是预测 的死亡率，和吸烟者抑郁情绪不太可能戒烟后ACS 住院因此，一种针对抑郁情绪和吸烟的单一综合治疗方法可能是可行的。 在降低ACS后死亡率方面非常有效。行为激活可能是一种理想的咨询治疗， 这一人口，因为它很容易培训，可以由学士学位水平的从业人员提供，并已 最近显示出提高抑郁症吸烟者戒烟效果的希望。通过广泛 试点工作我们系统地开发了一种咨询干预， 对ACS后吸烟者进行基于行为激活的情绪管理的戒烟咨询;行为 心脏吸烟者的激活治疗（BAT-CS）。本研究的总体目标是全面开展 有把握度的疗效试验，入组324例ACS吸烟者，并将其随机分配至12周BAT-CS或 控制（包括完全注意力匹配）。如果医学许可，两组都将提供尼古丁贴片。 将在治疗结束时和住院后6、9和12个月进行随访评估 放电我们将跟踪18 - 36年主要不良心脏事件的发生率和全因死亡率 出院后数月。主要结果将是抑郁情绪和生化验证的7天 点流行禁欲。本研究的具体目的是：目的I：检测BAT-CS与对照组相比的疗效 抑郁情绪和戒烟的效果目的II：测试BAT-CS与对照相比对心脏健康的有效性。 目的III：探索治疗效果的假设介质。目的四：探索时间的相互作用， 吸烟和多方面的情绪超过1年后ACS。这项研究的长期目标是 提高ACS后的长期生存率。

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.