Smoking Cessation The value of smoking cessation for the secondary prevention of cardiovascular disease has been demonstrated in several prospective observational studies. A meta-analysis of cohort studies in patients after acute MI showed that smoking cessa- tion reduced the subsequent cardiovascular mortality rate by ranking it among the most powerful secondary The SAVE (Sleep Apnea Cardiovas- cular Endpoints) study investigators reported that in selected patients with LV systolic dysfunction after MI, smoking ces- sation, compared with continued smoking, is associated with a 40% lower hazard of all-cause mortality and a 30% lower hazard of death, recurrent MI, or HF hospitalization.605 Reasonable evidence from RCTs indicates that counseling hospitalized smokers after acute MI increases smoking cessa- tion rates, provided that the initial contact during the hospital stay is followed by repeated contacts, usually by telephone, for 3 months after discharge.603,604 Similarly, the odds of smoking cessation are greater among patients who receive discharge recommendations for cardiac rehabilitation.604 Patients with depressive symptoms during the MI hospitaliza- tion and early convalescence are less likely to quit smoking and may require more intensive treatment to achieve cessa- Counseling should be provided to the patient and family, along with pharmacological therapy as deemed safe, and access to formal smoking-cessation programs should be facilitated. 11.1.3. 