Objective: The aim of this study was to evaluate the effect of a smoking cessation intervention provided after discharge from a specialized cardiac hospital. Design: A randomized pilot study (n = 40); after discharge, the experimental group (EG) received six phone calls from a nurse specialized in tobacco cessation counseling. Results: Patients in the EG showed improved scores on two aspects of illness representations (perceiving their illness as chronic and reporting fewer negative emotional representations). No significant difference in smoking cessation was observed at six months (p = 0.72). Conclusion: The non-significant difference may be explained in part by the smoking characteristics within this sample, exemplifying the more nicotine dependent “hardcore” smokers who persist in their smoking habits despite the serious health consequences incurred by continued smoking. This population of smokers may require a more intensive, specialized intervention to achieve smoking cessation.