Are You Missing Opportunities to Educate Patients on Smoking Cessation?

HealthDay News — Few smokers hospitalized for coronary heart disease (CHD) receive smoking cessation pharmacotherapy (SCP), according to a research letter published online in JAMA Internal Medicine.

Quinn R. Pack, MD, from Baystate Medical Center in Springfield, Mass, and colleagues conducted a retrospective study of 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 received percutaneous coronary intervention or coronary artery bypass surgery were included.

The researchers found that 22.7%  of the 36,675 smokers with CHD received at least one SCP during the hospitalization. Nicotine patch was the most common medication (20.4%) at a median dosage of 21 mg/d. Nicotine gum (0.3%), lozenge (0.04%), and inhaler (0.2%); bupropion (2.2%); and varenicline (0.4%) were also used. Patient-level factors most associated with SCP receipt included chronic lung disease, depression, and alcohol abuse (OR, 1.64, 1.51, and 1.71, respectively). 

Considerable variation was seen across hospitals (median treatment rate, 22.3%). The hospital was the factor most associated with SCP receipt (median OR, 1.91); this correlation was not explained by hospital size, urban location, teaching status, or US region.

“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,” the authors write.

One author disclosed financial ties to UpToDate for smoking cessation chapters, and to Pfizer.

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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]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.3489