Background. This study examined how cognitive and affective constructs related to an acute health event predict smoking relapse following an acute cardiac health event. Methods. Participants were recruited from emergency departments and completed cognitive and emotional measures at enrollment and ecological momentary assessments (EMA) for 84 days postvisit. Results. Of 394 participants, only 35 (8.9%) remained abstinent 84 days postvisit. Time to relapse was positively associated with age, actual illness severity, self-efficacy, and quit intentions. Conclusions. Older, seriously ill patients with strong confidence and intentions to quit smoking remain abstinent longer after discharge, but most still relapse within three months.