Post Acute Coronary Event Smoking Study

Integrated Smoking Cessation and Mood Management for Cardiac Patients

Smoking and depressed mood are both predictive of mortality following Acute Coronary Syndrome. However, to date, no counseling treatment has been designed to target smoking cessation and manage mood in this population. This trial will test such a treatment based on Behavioral Activation, an approach that has shown promise as an integrated treatment for smoking and mood management in other populations.

The occurrence of Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) 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 (BA) may be an ideal treatment for this population as BA can easily integrate both mood and smoking cessation related goals and it focuses on addressing restriction of valued activities, which is common in the post-ACS population.

Thus, the overall aim of the current study is test a BA treatment manual that integrates smoking cessation and mood management for post-ACS smokers (Behavioral Activation Treatment for cardiac patients who smoke; BAT-CS). We will conduct an RCT (N=72) comparing BAT-CS (1 in-hospital session and 5-9 post-discharge sessions) to Standard Care (SC; 1 in-hospital session and 5 mailed packets of printed self-help materials). Differences in smoking cessation, depressed mood, and positive affect will be compared between conditions.

Inclusion Criteria:

• ACS diagnosis documented in medical record
• smoked 3 or more cigarettes per day before being hospitalized
• between the ages of 18-75
• fluent in English
• regular access to a telephone
• lives in the Providence, RI area
• willing to "strongly consider" an attempt to quit smoking at discharge

Exclusion criteria:

• limited mental competency (i.e., Mini-Mental Status exam < 20)
• presence of current psychosis, serious mental illness, or suicidality, expectation that patient will not live through 6 month study period
• currently regularly attending counseling for depression or smoking cessation and plans to continue after discharge