Smoking Cessation Intervention 6.10. Smoking Cessation Intervention COR LOE New, Revised, or Unchanged Smokers with AIS should receive in-hospital initiation of high-intensity behavioral interventions to promote smoking cessation. I A New recommendation. For smokers with an AIS, who receive in-hospital initiation of high-intensity behavioral interventions to promote smoking cessation, nicotine replacement therapy is recommended. I A New recommendation. A 2012 meta-analysis by the Cochrane group indicates that high-intensity behavioral interventions that begin during an index hospitalization and include at least 1 month of supportive contact after discharge increased smoking cessation rates after discharge (RR, 1.37 [95% CI, 1.27 1.48]; 25 trials). The estimate of the effect for each level of intervention intensity among patients with a cardiovascular diagnosis was very similar (RR, 1.42 [95% CI, 1.29 1.56]). Adding nicotine replacement therapy to an intensive counselling intervention increased smoking cessation rates A 2016 retrospective cohort study of Korean smokers with AIS assessed a timely intervention strategy versus historical controls who received Timely intervention comprised a certified nurse providing comprehensive education during admission and additional counseling after discharge. Timely intervention was associated with greater odds of sustained smoking cessation for 12 months. See Table XCIII and XCIV in online Data Supplement 1. Healthcare providers should strongly advise every patient with AIS who has smoked in the past year to quit. I C-EO Recommendation reworded for clarity from 2014 Secondary Prevention. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. It is reasonable to advise patients after ischemic stroke to avoid secondhand (passive) tobacco smoke. IIa B-NR Recommendation reworded for clarity from 2014 Secondary Prevention. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. For smokers with an AIS, in-hospital initiation of varenicline to promote smoking cessation might be considered. IIb B-R New recommendation. A 2012 meta-analysis by the Cochrane group indicates that high-intensity behavioral interventions that begin during an index hospitalization and include at least 1 month of supportive contact after discharge increased smoking cessation rates after discharge (RR, 1.37 [95% CI, 1.27 1.48]; 25 trials). The estimate of the effect for each level of intervention intensity among patients with a cardiovascular diagnosis was very similar (RR, 1.42 [95% CI, 1.29 1.56]). There was insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counseling increases cessation rates over what is achieved by counseling alone.391 A subsequent 2016 multicenter, double-blind, randomized, placebo-controlled trial in which 302 smokers hospitalized with an acute coronary syndrome were randomized to varenicline or placebo for 12 weeks showed that at 24 weeks abstinence rates were 47.3% in the varenicline group versus 32.5% in the placebo group. Continuous abstinence rates were 35.8% in the varenicline group versus 25.8% in the placebo group.393 Patients in both groups received low- intensity counseling. See Tables XCIII and XCIV in online Data Supplement 1. Powers et al 2019 Guidelines for Management of AIS e399 6.11. Stroke Education 6.11. Stroke Education COR LOE New, Revised, or Unchanged Patient education about stroke is recommended. Patients should be provided with information, advice, and the opportunity to talk about the impact of the illness on their lives. I C-EO Recommendation and COR unchanged from 2016 Rehab Guidelines. LOE revised. Additional reference support for this guideline is provided in online Data Supplement 1.394 544 Writing Group Disclosures Writing Group Member Employment Research Grant Other Research Support Speakers Bureau/ Honoraria Expert Witness Ownership Interest Consultant/ Advisory Board Other William J. Powers University of North Carolina, Chapel Hill None None None Wake Forest University Baptist Medical Center* None None None Alejandro A. Rabinstein Mayo Clinic None None None None None None None Teri Ackerson Saint Luke s Health System, AHA/ASA None None None None None None None Opeolu M. Adeoye University of Cincinnati None None None None None None None Nicholas C. Bambakidis University Hospitals, Cleveland Medical Center None None None None None None None Kyra Becker University of Washington School of Medicine, Harborview Medical Center None None None Defense and prosecution* None None None Jos Biller Loyola University Chicago None None None None None None None Michael Brown Michigan State University College of Human Medicine, Emergency Medicine None None None 2018 Defense, Sandberg, Phoenix & Von Gontard*; Kamykowski, Gavin & Smith* None None Cochrane (senior editor) Bart M. Demaerschalk Mayo Clinic, Mayo Clinic Hospital None None None None None None None Brian Hoh University of Florida None None None None None None None Edward C. Jauch Mission Health System Research Institute NINDS (StrokeNet coinvestigator)*; Diffusion Pharmaceuticals (PHAST-TSC DSMB member)* None None Plaintiff and defense* None Biogen* None Chelsea S. Kidwell University of Arizona None None None None None None None Thabele M. Leslie-Mazwi Massachusetts General Hospital None None None None None None None Bruce Ovbiagele UCSF None None None None None None None Disclosures (Continued) Phillip A. Scott University of Michigan Department of Emergency Medicine NIH (principal investigator) University of Michigan (co-medical director, Clinical Trials Support Unit)* None Expert testimony None None University of Michigan (associate chair, Research Department of Emergency Medicine) Kevin N. Sheth Yale University School of Medicine Astrocyte (advisory)*; Bard (PI, Stroke Trial) ; Biogen (PI Stroke Trial) ; Hyperfine (PI, Imaging Trial including stroke patients) ; Zoll (DSMB chair)* None None None Alva Health* Biogen* None Andrew M. Southerland University of Virginia Diffusion Pharmaceuticals, Inc (Prehospital Administration of Acute Stroke Therapy with Trans-sodium Crocetinate [PHAST- TSC]) ; NINDS UO1 Trial)*; NHLBI-NINDS (Cardiothoracic Surgical Trials Network) ; Coulter Translational Research Foundation (Brain and Neurological Deficit Identification Tool [BANDIT] Study)* None None Plaintiff and defense cases focused on questions related to stroke* iTREAT Project, US Patent Application No. BANDIT Project, US Provisional Patent Application No. None None Deborah V. Summers Saint Luke s Health System None None None None None None None David L. Tirschwell Harborview Medical Center NIH None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be significant if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity or owns $10000 or more of the fair market value of the entity. A relationship is considered to be modest if it is less than significant under the preceding definition. *Modest. Significant. Writing Group Disclosures Continued Writing Group Member Employment Research Grant Other Research Support Speakers Bureau/ Honoraria Expert Witness Ownership Interest Consultant/ Advisory Board Other Reviewer Disclosures Reviewer Employment Research Grant Other Research Support Speakers Bureau/ Honoraria Expert Witness Ownership Interest Consultant/ Advisory Board Other Mark J. Alberts Hartford HealthCare None None Genentech (speakers bureau) None None None None Joseph P. Broderick University of Cincinnati NIH (trial) ; NIH (investigator) Genentech (PRISMS) ; Genentech (TNK) None None None None None (Continued) Powers et al 2019 Guidelines for Management of AIS e401 Colin P. Derdeyn University of Iowa None None None None Pulse therapeutics* Penumbra* None Marc Fisher Beth Israel Deaconess Medical Center None None None None None None American Heart Association Karen L. Furie Rhode Island Hospital None None None None None None None Philip B. Gorelick Michigan State University None None None Employer received compensation for expert witness work None IMPACT clinical trial*; NeuroSpring* None Walter N. Kernan Yale University None None None None None None None Steven J. Kittner Veterans Affairs Maryland Health Care System; University of Maryland School of Medicine None None None None None None None Patrick D. Lyden Cedars-Sinai Medical Center NIH* None None None None None None Philip M. Meyers Columbia University None None None None None None None Jeffrey L. Saver UCLA None None None None Rapid Medical* Medtronic*; Stryker*; Neuravi/ Ceronovus*; Boehringer Ingelheim*; St. Jude Medical* University of California (employer)* Steven Warach University of Texas at Austin State of Texas None None Private law firm* Stock holdings in various pharma companies in a managed investment portfolio (myself)*; stock holdings in various pharma companies in a managed investment portfolio (family)* Genentech* None Lawrence R. Wechsler University of Pittsburgh None None None None None None None Babu G. Welch UT Southwestern Medical Center None None Stryker Neurovascular (speakers bureau)*; Stryker Neurovascular (honoraria)* None None Stryker Neurovascular* None This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be significant if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10000 or more of the fair market value of the entity. A relationship is considered to be modest if it is less than significant under the preceding definition. *Modest. Significant. 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