Smokers Hospitalized for CHD Do Not Receive Adequate Cessation Therapy

Only about 22.3% of smokers who are hospitalized for coronary heart disease (CHD) receive smoking cessation therapy while hospitalized, according to a recent study.

The Joint Commission now views inpatient use and discharge prescriptions of smoking cessation pharmacotherapy as standard care. However, despite the benefits of these therapies, little data exists on their use across the country, and no estimates exist among patients hospitalized for CHD.
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To conduct their study, the researchers retrospectively evaluated 26,675 smokers with CHD at 282 US hospitals that participated in the Premier Alliance database in 2014. Active smokers who were admitted with a principal diagnosis of myocardial infarction or who had received percutaneous coronary intervention or coronary artery bypass surgery met the inclusion criteria for the study.

The researchers assessed the use of varenicline tartrate, bupropion hydrochloride, and nicotine replacement therapy, including the nicotine patch, gum, lozenge, and inhaler. Independent patient and hospital factors associated with receiving smoking cessation therapies were identified via hierarchical generalized logistic regression modeling.

Results indicated that 8316 (22.7%) participants received at least 1 smoking cessation pharmacotherapy while hospitalized. The most common prescribed medication was the nicotine patch (20.4%) at a median dosage of 21 mg/d. Patients with chronic lung disease, depression, and alcohol abuse were more likely to be prescribed cessation medication.

Hospital use of smoking cessation pharmacotherapies varied substantially across the United States, with a median treatment rate of 22.3%. Although hospitalization was the factor most associated with receiving smoking cessation pharmacotherapy, this association was not explained by the hospital size, urban location, teaching status, or region of the United States.

“Hospitalization for a cardiac event provides a teachable moment with high patient motivation to quit smoking; however, our findings suggest that many hospitals are missing this opportunity to improve outcomes for smokers hospitalized for CHD,” the researchers concluded. “We hope these results will encourage physicians and hospital administrators to evaluate local practice patterns and consider quality improvement initiatives to provide every smoker the necessary support to quit permanently.”

—Christina Vogt

Reference:

Pack QR, Priya A, Lagu TC, Pekow PS, Rigotti NA, Lindenauer PK. Smoking cessation pharmacotherapy among smokers hospitalized for coronary heart disease [Published online August 21, 2017]. doi:10.1001/jamainternmed.2017.3489.