Smoking-Cessation Therapy for Hospitalized Smokers Heavily Underutilized

Only one-third of heart disease-related hospitalization receive smoking-cessation therapy, according to a study presented at the American College of Cardiology’s 66th Annual Scientific Session in Washington, DC.

Research has shown that quitting smoking can reduce the risk of heart attack, stroke, or death. Despite this, a new study found that smoking cessation therapies are significantly underutilized among hospitalized smokers with coronary heart disease.

In fact, over the last decade, smoking-cessation treatments only increased by 10% in hospitals nationwide.

“Hospitalization is usually a highly teachable moment, when patient motivation to quit smoking is really high,” said lead author Quinn R. Pack, MD, MSc. “Yet our study suggests that two-thirds of these patients leave the hospital without having been given evidence-based smoking-cessation tools that we know can help them quit.”

For the study, investigators used diagnostic and billing data from 282 hospitals across the country to determine how often smokers hospitalized for heart attacks or heart surgery received smoking-cessation, counseling, nicotine replacement therapy, or a smoking-cessation medication during their hospital stay. Data for 36,675 patients coded as active smokers at hospital discharge between 2004 and 2014 were reviewed.

Nearly 70% of patients were men, with an average age of 58, and 63% were hospitalized for a heart attack. The hospitals from medium-sized community hospitals to large university-affiliated medical centers.

The results of the study showed that approximately 30% of patients received at least 1 smoking-cessation therapy while hospitalized. Of these patients, approximately 20% received the nicotine patch, and about 10% received professionally delivered smoking-cessation counseling.

Few of the patients received medication or other forms of nicotine replacement therapy, according to the study. Smokers who had lung disease, consumed alcohol, were depressed, or were younger than 58 years were statistically significantly more likely to receive smoking-cessation therapy.

The use of smoking-cessation therapies among smokers treated for heart disease varied widely across the hospitals.

“We found that some hospitals were getting just over half of their patients on smoking-cessation treatment, while at other hospitals, less than 10% of patients who could benefit from smoking-cessation treatment were receiving it,” Pack said. “Smoking is the number one behavior that predicts early all-cause death. Hospitals and cardiologists can do more to help patients who smoke get the treatment they need to help them quit.”

Some limitations to the study were that investigators were unable to examine whether patients stopped smoking, and the diagnostic codes used to identify patients as smokers may have missed some patients who should have been included in the study.

“The data we examined cannot tell us whether patients actually quit smoking,” Pack said. “We only know if they received smoking-cessation therapy while they were hospitalized because that creates a billing record. We also don’t know whether some patients were offered smoking-cessation therapy but declined.”

Pack noted that prior research has demonstrated safety and efficacy of nicotine replacement therapy and smoking-cessation medications in helping non-hospitalized individuals quit smoking.

“It has not been definitely proven in a randomized controlled trial that nicotine replacement therapy after a heart attack improves quit rates.” Pack said. “But, we do know that, in general, patients who receive nicotine replacement therapy in the hospital are more likely to continue to use it after they are discharged and that it improves quit rates in the general population of smokers.”

In the next steps, the investigators plan to identify the strategies and practices used by high performing hospitals to provide patients with smoking-cessation tools and medications to help implement better systems in other hospitals.