A new study suggests that people, who quit smoking after being hospitalized for signs of a heart attack, but start again after their release, may triple their risk of dying.

Reuters reports that the Italian study found people who started smoking again after they were hospitalized for signs of a heart attack had more than triple the risk of dying in the next year, compared with those who stayed smoke free.

The researchers followed 1,294 patients who were regular smokers before they were hospitalized. They all had quit smoking while in the hospital, received brief counseling sessions to help them quit smoking and did not receive any other smoking-cessation assistance once they left the hospital. The researchers found that at the end of one year, 813 patients had resumed smoking, and 97 patients had died—81 of them from heart-related causes.  They calculated that patients who starting smoking again after leaving the hospital had three times the risk of dying compared with patients who didn’t take up smoking again.

The sooner a patient started smoking again, the greater the risk he or she would die within a year. Patients who quit for six months were unlikely to start smoking again. The researchers recommend that smoking cessation counseling be integrated into post-discharge plans for patients hospitalized with heart problems. Their findings appear in the American Journal of Cardiology.