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Many Hospitals Fail to Support Smoking Cessation for CHD Patients

Over 22 percent of smokers hospitalized due to coronary heart disease (CHD) were highly motivated to stop smoking and received pharmacotherapy aimed at improving smoking cessation during their hospitalization.

According to the study analyzing data from 282 hospitals located in the U.S., the highest performing hospitals initiated smoking cessation treatment in nearly two-thirds of patients while the lowest performing hospitals only initiated therapy “in less than 10 percent” of patients.

"The hospital was a more important predictor of receiving smoking cessation counseling and treatment than the patient," said Quinn Pack, MD, of Baystate Medical Center. "We saw big hospitals, small hospitals, urban, not urban all vary widely across the range, and none of these variables were predictive."

Another study published in JAMA Cardiology revealed a low utilization of smoking cessation medication among older patients who were hospitalized due to a heart attack. In fact, only 7 percent of these patients filled smoking-cessation drug prescriptions within 90 days of being discharged from the hospital.

“...we are really missing the boat when it comes to helping patients at this very critical time. This is really about the administration and the hospital culture. Some hospitals are really pushing this, and at others, smoking cessation treatment doesn't seem to be on the radar," said Pack.

Throughout their studies focusing on 36,675 smokers with CHD, the researchers effectively identified patient and hospital factors that contributed to the use of smoking cessation pharmacotherapy (SCP), as well as the rate of influence each hospital had on a patient’s probability of receiving SCP.  A nicotine patch was the most commonly used medication with patients also choosing to use nicotine gum, lozenge, inhalers, bupropion and varenicline. 

It was also discovered that the “patient-level factors most associated with receipt of SCP” included chronic lung disease, alcohol abuse and depression. A 6 percent increase in mean hospital SCP rate increased between the years of 2004 and 2011, yet there was only a 2 percent increase realized between 2011 and 2014.  

"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," wrote Pack's group.

To support smoking cessation efforts, it is recommended that hospitals are equipped with smoking cessation protocol and counselors on staff.

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