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Citation Information

Type Thesis or Dissertation - Master of Public Health
Title Smoking Cessation after Acute Myocardial Infarction among Patients of Nork-Marash Medical Center in Armenia: a Cross-Sectional Survey
Publication (Day/Month/Year) 2016
URL http://sph.aua.am/files/2016/06/Thesis_Varduhi_Hayrumyan.pdf
Background: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in
the world. Myocardial infarction (MI) is one of the major clinical manifestations of CAD. One
of the main modifiable risk factors for developing and recurrence of CAD is smoking. Smoking
cessation after MI is associated with considerably lower mortality rate. The aim of the study was
to investigate the smoking cessation practices and the factors associated with smoking cessation
at 6 to 12 months after hospitalization among patients who were hospitalized at Nork-Marash
Medical Center (NMMC) in Yerevan, Armenia with acute MI (AMI).
Methods: A cross-sectional survey was carried out in April 2016. All smoker AMI patients
above age 18 who had experienced acute MI and were hospitalized at NMMC from March 2015
to August 2015 were included in the study. Data collection was done through medical chart
review and interviewer administered telephone survey. The survey questionnaire included
questions on socio-demographic characteristics, smoking behavior, nicotine dependence, selfefficacy,
social support, and depression. Descriptive, comparative, simple and multiple logistic
regression analysis were performed using STATA 13 software.
Results: Among 214 AMI patients hospitalized in NMMC, 58.88% were smokers. All 103
patients who participated in the study were males. The mean age of the participants was 58.73
(SD: 8.87). Almost all the smoker patients attempted to quit smoking after AMI, but only
54.37% of patients maintained non-smoking status at 6-12 months. Most of the patients
(87.38%) reported that they had received the smoking cessation advice, but no assistance and no
follow up arrangement were provided. The nicotine dependence level was identified as an
independent predictor of smoking cessation after AMI with OR of 0.34 (OR=0.34, 95% CI: 0.20-
0.57, p<0.001). Self-efficacy was another independent predictor of smoking cessation after AMI
with an OR of 1.30 (OR=1.30, 95% CI: 1.15-1.46, p<0.001).
Conclusion: The present study was the first attempt to investigate smoking cessation practice
and factors associated with it in Armenian population. The findings show that the recommended
standard care for smoking cessation was not provided in the medical setting and 45.63% of
patients continued smoking at 6-12 months after AMI. The level of nicotine dependence and
self-efficacy were independent predictors of smoking cessation at 6 to 12 months after AMI.
Further research is needed to better understand smoking cessation practices among AMI patients.
The study suggests the need for the integration of recommended standard smoking cessation
services into medical care for all AMI patients. In addition, the health care professionals should
implement assessment of nicotine dependence level and /or self-efficacy of patients to identify
those patients who are more likely to continue smoking and provide more intensive assistance.

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