They may struggle with high dependence on nicotine, severe withdrawal problems, low self-confidence, poor social support, weight gain, comorbid psychiatric illnesses, and suboptimal use of Addressing each of these issues as they arise is critical to achieving smoking cessation. In addition, criti- cal evaluation of the helpful and unhelpful aspects of prior attempts at smoking cessation can guide the development of revised and more effective treatment plans. Even among those smokers who have initial success, it is important to remain focused on these issues because most smokers try quitting several times before they finally achieve durable success.316 Ultimately, successful smoking cessation strategies require a long-term disease management approach to achieve perma- nent abstinence. Smoking Cessation Recommendations 1. Smoking cessation is critical, and counseling should be offered to all patients who smoke, during and after hospitalization for CABG, to help improve both short- and long-term clinical outcomes after surgery (Class I; Level of Evidence A). 2. It is reasonable to offer nicotine replacement therapy, bupropion, and varenicline as adjuncts to smoking cessation counseling for stable CABG patients after hospital discharge (Class IIa; Level of Evidence B). 3. Nicotine replacement therapy, bupropion, and var- enicline may be considered as adjuncts to smoking cessation counseling during CABG hospitalization, but their use should be carefully considered on an individualized basis (Class IIb; Level of Evidence B). 