Assessment of smoking care by stroke specialists in patients with recent TIA and minor stroke: an international prospective registry-based cohort study.

The objectives are to assess smoking abstinence and its effects on vascular risk and to report tobacco-cessation counselling and pharmacotherapy use in patients who had a recent minor stroke or transient ischaemic attack (TIA). The TIA registry.org project is a prospective, observational registry of patients with TIA and minor stroke that occurred in the previous 7 days with a 5-year follow-up, involving 61 sites with stroke specialists in 21 countries (Europe, Asia, Latin America and Middle East). Of those, 42 sites had 5-year follow-up data on more than 50% of their patients and were included in the present study. From June 2009 through December 2011, 3847 patients were eligible for the study (80% of the initial cohort). Tobacco counselling and smoking-cessation pharmacotherapy use in smoking patients were reported at discharge. Association between 3-month smoking status and risk of a major cardiovascular event (MACE) was analysed with multivariable Cox regression model. Among 3801 patients included, 835 (22%) were smokers. At discharge, only 35.2% have been advised to quit and 12.5% had smoking-cessation pharmacotherapy prescription. At 3 months, 383/835 (46.9%) baseline smokers were continuers. Living alone and alcohol abuse were associated with persistent smoking; high level of education, aphasia and dyslipidaemia with quitting. The adjusted HRs for MACE at 5 years were 1.13 (95% CI 0.90 to 1.43) in former smokers, 1.31 (95% CI 0.93 to 1.84) in quitters and 1.31 (95% CI 0.94 to 1.83) in continuers. Using time-varying analysis, current smoking at the time of MACE non-significantly increased the risk of MACE (HR 1.31 (95% CI 0.97 to 1.78); p=0.080). In the TIAregistry.org, smoking-cessation intervention was used in a minority of patients. Surprisingly, in this population in which, at 5 years, other vascular risk factors were well controlled and antithrombotic treatment maintained, smoking cessation non-significantly decreased the risk of MACE.

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Competing interests: PL has nothing to disclose. PA reports receipt of research grant support from Pfizer, Sanofi, Bristol-Myers-Squibb, AstraZeneca, Boston Scientific, AltheraPharmaceutical, and from the French government, and consulting fees from Pfizer, BMS, AstraZeneca, Johnson and Johnson, Kowa, Amgen, and lecture fees from Amgen, Pfizer, Sanofi. P-JT reports royalties from IP in IMT Company and is a stockholder in IMT. GWA reports equity interest: iSchemaView, and consultant fees from Medtronic, iSchemaView, Janssen, and Biogen. GAD reports unrestricted research grant from Sanofi, speaker and advisory board fees from Boehringer Ingelheim, Bristol Myer Squibb, Pfizer and Bayer companies. JMF reports having received fees as speakers bureau from Boehringer-Ingelheim, consultant fees from GSK, Ferrer and Servier. PGS discloses the following relationships: research grants: Amarin, AstraZeneca, Bayer, Sanofi, and Servier Clinical Trials (Steering committee, CEC, DSMB): Amarin, AstraZeneca, Bayer, Bristol-Myers Squibb, Idorsia, Janssen, Novartis, PhaseBio, Pfizer, Sanofi, Servier Consulting or speaking: Amarin, Amgen, BMS, Novo-Nordisk, Regeneron Senior Associate Editor at Circulation Bayer, Boehringer-Ingelheim, BristolMyersSquibb, Idorsia, Mylan, NovoNordisk, Novartis, Pfizer, Regeneron, Sanofi, Servier. HC has nothing to disclose. JL has nothing to disclose. MGH has nothing to disclose. SU reports receipt of research grants, consultancy fees, and lecture fees from Sanofi, Bayer, Otsuka, Boehringer-Ingelheim, and Daiichi-Sankyo, and research grants from the Japanese Ministry of Health, Labour, and Welfare and Japan Cardiovascular Research Foundation. EV reports Consulting/speaking honoraria from Abbott, Amgen, BMS, Fresenius, GSK, Medtronic, Pfizer, Sanofi, Stallergenes. LKSW reports honoraria as a member of a steering committee for Johnson & Johnson, Astra Zeneca and Bayer; honoraria for participation in clinical trials, contributions to advisory boards, or oral presentations from Bayer, Sanofi-Aventis, Bristol-Myers Squibb, Boehringer Ingelheim, and Pfizer. CAM serves in the Steering Committee of CLOTBUST-ER trial (Cerevast); SOCRATES (AstraZeneca), IMPACT-24b (Brainsgate), REVASCAT (Fundació Ictus Malaltia Vascular). He has received honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from: Astra Zeneca: Boeringher Ingelheim, Daichii Sankyo, BMS, Covidien, Cerevast, Brainsgate. CAM has no ownership interest and does not own stocks of any pharmaceutical or medical device company. PR has received Advisory Board fees from Pfizer, Sanofi, Bristol-Myers-Squibb, AstraZeneca, Boehringer-Ingelheim, Bayer and Daiichi-Sankyo.