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Patients hospitalized for CHD often fail to receive smoking cessation medication
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Fewer than one-quarter of smokers hospitalized for CHD received smoking cessation pharmacotherapy during their stay, according to a research letter published in JAMA Internal Medicine.
The Joint Commission considers inpatient use of smoking cessation pharmacotherapy and prescription for it at discharge standard of care, but little was known about its use in patients hospitalized for CHD, according to the study background.
Quinn R. Pack, MD, MSc, medical director of cardiovascular rehabilitation and wellness at Baystate Medical Center in Springfield, Massachusetts, and colleagues conducted a retrospective study of 36,675 smokers (mean age, 58 years; 69% men) hospitalized for CHD at 282 institutions between 2004 and 2014. Sixty-three percent of the patients had MI; the rest underwent PCI or CABG for stable CHD.
The researchers analyzed the frequency of use of varenicline, buproprion and nicotine replacement therapy — including the nicotine patch, gum, lozenge and inhaler — and characteristics predictive of smoking cessation pharmacotherapy use.
Among the cohort, only 22.7% received at least one smoking cessation pharmacotherapy while hospitalized, according to the researchers.
The most frequently used pharmacotherapy was the nicotine patch (median dosage, 21 mg per day), which was used by 20.4% of patients. Buproprion (2.2%), varenicline (0.4%) nicotine gum (0.3%), nicotine inhaler (0.2%) and nicotine lozenge (0.04%) were used in few patients.
Factors most associated with use of smoking cessation pharmacotherapy were alcohol abuse (OR = 1.71; 95% CI, 1.56-1.87), chronic lung disease (OR = 1.64; 95% CI, 1.55-1.73) and depression (OR = 1.51; 95% CI, 1.4-1.64), Pack and colleagues wrote.
There was wide variation among hospitals in rate of smoking cessation pharmacotherapy use (median, 22.3%; 10th percentile, 9.6%; 90th percentile, 36.7%). Rates increased 6% from 2004 to 2011 but only 2% between 2011 and 2014, according to the researchers.
Hospital was significantly associated with receipt of smoking cessation pharmacotherapy (median OR = 1.91; 95% CI, 1.77-2.04), but the association was not consistent by hospital size, urban vs. rural location, teaching status or geographic region.
“These findings may reflect differences in hospital policies, physician inexperience with prescribing [smoking cessation pharmacotherapy] or lingering concerns about the safety of [smoking cessation pharmacotherapy] in patients with CHD,” the researchers wrote. “Our findings suggest that many hospitals are missing [an] opportunity to improve outcomes for smokers hospitalized with CHD.” – by Erik Swain
Disclosure: One author reports receiving royalties from UpToDate for smoking cessation chapters, receiving a research grant from Pfizer and consulting without honorarium for Pfizer.
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