The prognostic effect of cigarette smoking on stroke severity, disability, length of stay in hospital, and mortality in a cohort with cerebrovascular disease.

OBJECTIVE: The aim of this study was to determine the prognostic influence of cigarette smoking on stroke severity, disability, length of stay (LOS) in hospital, and mortality in different stroke types. METHODS: A cohort separated by smoking status from the Registry of the Canadian Stroke Network was analyzed using logistic regression while controlling for key outcomes and clinical and demographic characteristics. RESULTS: There were 20,523 patients that were included for this study from July 2003 to March 2008. Multivariable analyses revealed that, in general, long-time smoking had a negative effect on functional outcome at discharge, mortality at 1 year, and LOS in hospital. In general, former smoking had a positive impact in reducing the risk of severe stroke, mortality risk at 30 days, and the LOS in hospital. Significant differences in clinical and demographics were found between smokers, nonsmokers, and former smokers with cerebrovascular disease. On average, smokers had an earlier initial stroke presentation of cerebrovascular disease. CONCLUSIONS: Our results provide empirical evidence regarding the prognostic influence of cigarette smoking on stroke severity, disability, and LOS in hospital and mortality, but the magnitude of the effect varied by stroke type.

Correlates of former smoking in patients with cerebrovascular disease: a cross-sectional study.

OBJECTIVE: To identify multilevel correlates of former smoking in patients with cerebrovascular disease. DESIGN: Secondary data analysis of the Canadian Community Health Survey. METHODS: We used data from the 2007-2008 Canadian Community Health Survey (CCHS). Smoking status (former smoking vs smoker) was described by multilevel correlates of former smoking. A multilevel approach for variable selection for this study was used to understand how multiple levels in society can have an impact on former smoking. The study sample was selected from those respondents of the CCHS that reported they suffered from stroke symptoms. Logistic regression was used to predict former smoking in patients with cerebrovascular disease while controlling for multilevel confounders. Proportions were weighted to reflect the Canadian population. RESULTS: There were 172 355 respondents who reported to suffer from stroke. From this sample, 36.5% were smokers and 63.5% were former smokers. Age groups 55-69 and 70-80 and higher education (secondary education +) were positively related to former smoking. Household and vehicle smoking restrictions significantly predicted former smoking. Counselling advice from a physician and having access to a general practitioner were correlates of former smoking. Finally, the use of buproprion was positively related to former smoking. CONCLUSIONS: There are multilevel correlates of former smoking in smokers with reported stroke symptoms. These correlates include older age groups, higher education, household and vehicle smoking restrictions, pharmacotherapy use (bupropion), access to a general practitioner and counselling advice from a physician.

The effectiveness of smoking cessation interventions in smokers with cerebrovascular disease: a systematic review.

OBJECTIVE: The main objective of this study was to determine the effectiveness of smoking cessation interventions (SCIs) for increasing cessation rates in smokers with cerebrovascular disease. DESIGN: Systematic review. Two independent reviewers searched information sources and assessed studies for inclusion/exclusion criteria. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: Randomised control trials, conducted prior to the 22 May 2012 investigating SCIs in smokers with cerebrovascular disease, were included. No age or ethnicity limitations were applied in order to be as inclusive as possible. METHODS: We followed the PRISMA statement approach to identify relevant randomised control studies. Due to the variability of interventions used in the reported studies, a meta-analysis was not conducted. RESULTS: Of 852 identified articles, 4 articles fit the inclusion criteria describing the outcome in 354 patients. The overall cessation rate with an SCI was 23.9% (42 of 176) while without one was 20.8% (37 of 178). CONCLUSIONS: There are a limited number of reported intervention studies that explore this area of secondary stroke prevention. Furthermore, of those intervention studies that were found, only two implemented evidence-based approaches to smoking cessation. A meta-analysis was not conducted because of the variability of interventions in the reported studies. Larger studies with homogeneous interventions are needed to determine how effective SCIs are in increasing cessation in smokers with established cerebrovascular disease.