Smoking damages the heart in a number of ways, including speeding up
plaque formation in the arteries, reducing blood flow, raising
cholesterol and promoting blood clots, among other negative effects.
Experts say quitting smoking can cut the risk of repeat heart attacks
and death from heart disease by about half.
Even after heart surgery,
research has shown that quitting smoking reduces the risk of a heart
attack, stroke or death.
‘About one-third of smokers hospitalized for heart attacks and other serious heart problems received proven smoking-cessation therapy while they were in the hospital.’
Yet only about one-third of smokers
hospitalized for heart attacks and other serious heart problems received
proven smoking-cessation therapy while they were in the hospital,
according to research scheduled for presentation at the American College
of Cardiology's 66th Annual Scientific Session.
Moreover, data showed
that amid mounting evidence of the dangers of tobacco smoke, use of
smoking-cessation treatments only increased by 10% in hospitals
nationwide over the last decade.
"Hospitalization is usually a highly teachable moment, when patient
motivation to quit smoking is really high," said Quinn R. Pack, a preventive cardiologist at Baystate Medical Center in Springfield,
Massachusetts, and lead author of the study. "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
Pack and his colleagues examined diagnostic and billing data from
282 hospitals to determine how often smokers hospitalized for heart
attacks or heart surgery received smoking-cessation counseling, nicotine
replacement therapy (such as the nicotine patch, gum, lozenge or
inhaler) or a smoking-cessation medication (varenicline or bupropion)
during their hospital stay. The researchers reviewed data for 36,675
patients coded as active smokers at hospital discharge between 2004 and
Nearly 70% were men, their average age was 58, and 63% of them were hospitalized for a heart attack. The hospitals were
located across the country and ranged from medium-sized community
hospitals to large university-affiliated medical centers. All of the
hospitals had voluntarily submitted the data, stripped of information
that might identify individual patients, to a large quality-improvement
Overall, about 30% of the patients received at least one
smoking-cessation therapy during their hospital stay. Of those, about 20% were given the nicotine patch, which was the most commonly
given treatment, and about 10% received professionally delivered
smoking-cessation counseling. Few patients received medication or other
forms of nicotine replacement therapy such as nicotine gum or lozenges.
Smokers who had lung disease, used alcohol, were depressed or were
younger than 58 years of age were statistically significantly more
likely to receive smoking-cessation therapy.
The study also found wide variation across hospitals in the use of
smoking-cessation therapies among smokers being treated for heart
disease, Pack said.
"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," he said.
This research points to "a sizeable performance gap" among hospitals and cardiologists, Pack said.
"Smoking is the number one behavior that predicts early all-cause
death," he said. "Hospitals and cardiologists can do more to help
patients who smoke get the treatment they need to help them quit."
The study has limitations.
"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."
Another limitation is that the diagnostic codes used to identify
patients as smokers may have missed some patients who should have been
included in the study.
Previous research has shown that nicotine replacement therapy and
smoking-cessation medications are safe and effective in helping
nonhospitalized smokers quit, Pack said.
"It has not been definitely proven in a randomized controlled trial
that nicotine replacement therapy after a heart attack improves quit
rates," he 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."
Pack said he and his research team plan to identify the strategies
and practices high performing hospitals use to provide patients with
smoking-cessation tools and medications so that other hospitals can
follow their examples and learn from their experiences.