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Immediate Reduction in Acute Myocardial Infarctions After the Implementation of a Comprehensive Smokefree Ordinance Richard P. Sargent, Presenter American College of Cardiology 52nd Annual Scientific Sessions March 30-April 2, 2003 Chicago, IL

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Immediate Reduction in Acute Myocardial Infarctions After the Implementation of a Comprehensive Smokefree Ordinance

Richard P. Sargent, Presenter

American College of Cardiology

52nd Annual Scientific Sessions

March 30-April 2, 2003 Chicago, IL


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Immediate Reduction in Acute Myocardial Infarctions After Implementation of a Comprehensive Smokefree Ordinance

AUTHORS

Richard P. Sargent, MD Stanton A. Glantz, PhD

Robert M. Shepard, MD Division of Cardiology

HealthCare Quality Performance Council Department of Medicine

St. Peter’s Community Hospital University of California

2475 Broadway San Francisco, CA 94143

Helena, Montana 59601

The following relationships exist related to this presentation:

Dr. Sargent's travel expenses to ACC Scientific Session supported by ProtectMontanaKids, a project of the American Cancer Society, American Heart Association, and American Lung Association of the Northern Rockies, with support from the Robert Wood Johnson Foundation.

Dr. Glantz’ work was supported by National Cancer Institute Grant CA-61021 and the American Legacy Foundation.

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Passive and Active Smoking Cause Heart Disease

  • SHS increases risk of cardiac event by 30%

  • Effects on platelets

  • Effects on endothelium

  • Effects on heart rate variability

  • Smokefree workplaces are associated with a 29% drop in cigarette consumption


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Helena, Montana

Population of city: 28,306

Population of Helena Zip Codes: 46,943

Total Population of Study area: 65,913

Geographically isolated population

Next nearest cardiologist: 60 miles


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Area Hospitals

  • St.Peters Community Hospital, Helena, MT

    • 99 Beds, Two cardiologists

  • Broadwater Health Center, Townsend, MT

    • 9 beds, Two Family Practitioners

    • 30 Miles SE of Helena

  • Ft. Harrison VAMC, Helena, Montana

    • No After hours admissions


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JUNE 4, 2002 ORDINANCE PASSES

P Smokefree

Workplaces

Restaurants

Bars

Casinos

P 62% vote for ordinance

P Took effect June 5

P Widespread compliance

P Suspended by court December 2


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HOSPITAL COMPUTERIZED MEDICAL RECORD

Collect data for 4 years before ordinance to establish time trends and seasonal variation

Compare AMI’s in Helena Zip Codes

v.

AMI’s in Zip Codes Not in Helena


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STUDY DESIGN

  • COMPUTER SEARCH FOR ALL RECORDS WITH PRIMARY OR SECONDARY DIAGNOSIS OF AMI

  • CHART REVIEW OF ALL SECONDARY DIAGNOSES AND ALL PATIENTS WITH OUT OF AREA ZIP CODES TO ASSIGN TO THE STUDY GROUP

  • SORT CASES BY ZIP CODE


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INCLUSION CRITERIA

Discharge Diagnosis of Acute Myocardial Infarction

PResident of the Area OR

PSpent the Night Preceding the MI in the Study Area OR

PAte at Least One Meal in the Area Prior to the onset of Symptoms. AND

PSymptoms Began Prior to Hospitalization

PNo Complicating Condition or Surgery


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STATISTICAL ANALYSIS

Multiple Linear Regression

Dependent Variable:

AMI admissions for month

Independent variables:

Time

Month

Presence of Ordinance

0,1 dummy variable


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In Helena: Significant fall of –4.01.2 AMI admissions per month (P=.002) while ordinance is in force

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Outside Helena: No significant change in AMI admissions per month (+0.9+0.7; P=0.22) while ordinance is in force

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CONCLUSIONS

  • Helena, Montana’s Clean Indoor Air Ordinance Decreased Acute Myocardial Infarction by 60% compared to the same time period in the previous four years.

  • Result is biologically plausible

  • Suggests that 100% smokefree ordinances have an important and immediate effect on cardiac risks

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