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SMOKING CESSATION THERAPIES ARE PERSISTENTLY AND SIGNIFICANTLY UNDERUTILIZED AMONG HOSPITALIZED SMOKERS WITH CORONARY HEART DISEASE
1755 JACC March 21, 2017 Volume 69, Issue 11
Prevention SMOKING CESSATION THERAPIES ARE PERSISTENTLY AND SIGNIFICANTLY UNDERUTILIZED AMONG HOSPITALIZED SMOKERS WITH CORONARY HEART DISEASE Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Current Issues in Cardiovascular Epidemiology, Disparities, and Safety Abstract Category: 32. Prevention: Clinical Presentation Number: 1148-064 Authors: Quinn R. Pack, Aruna Priya, Tara Lagu, Penelope Pekow, Nancy Rigotti, Peter Lindenauer, Baystate Medical Center, Springfield, MA, USA, Massachussetts General Hospital, Boston, MA, USA Background: Smoking cessation (SC) is the single most effective behavior change that patients can make after a hospitalization for coronary heart disease (CHD) to prevent recurrent events. Furthermore, inpatient SC therapy coupled with outpatient follow-up can significantly improve long-term SC rates, but little is known about how often SC therapies are used among hospitalized patients.
Methods: Using billing data and ICD-9 codes from a diverse group of hospitals participating in Premier Inc. database in 2014, we examined how often nicotine replacement (patch, gum, lozenge, inhaler), varenicline, and bupropion were administered to current smokers hospitalized for myocardial infarction (MI), percutaneous coronary intervention, or coronary artery bypass surgery. We also examined rates of professional SC counseling, patient factors associated with use of SC therapies, and trends in hospital rates of SC therapies starting from 2004. Results: At 282 hospitals with ≥ 25 smokers in 2014, we included 36,675 patients (58 ± 9 years, 69% male, 63% with MI.) Overall, 29.9% of patients received at least one kind of SC therapy during the hospitalization. The most common therapy was the nicotine patch (20.4%) at an average daily dose of 19.8 mg, followed by professional counseling (9.6%). Fewer patients received bupropion (2.2%), gum (0.3%), lozenge (0.04%), inhaler (0.2%), or varenicline (0.4%). Smokers with lung disease, depression, alcohol use, and younger age were more likely to receive a SC therapy (p<0.001 for all). Additionally, there was substantial variation in use of SC therapies across hospitals with a median (10th - 90th percentile) treatment rate of 26.2% (11.4% to 51.1%.) Between 2004 and 2014, there was a 10.0 % absolute increase (p <0.001) in the mean rate of SC therapy use across hospitals. Conclusions: In a large sample of smokers with CHD at multiple hospitals, we found that only a minority of patients received any SC therapy and that this percentage has increased only modestly in the past 10 years. Given that hospitalization is usually a teachable moment with high patient motivation to quit smoking, there appears to be a large opportunity for improvement in the care of smokers hospitalized with CHD.
Prevention SMOKING CESSATION THERAPIES ARE PERSISTENTLY AND SIGNIFICANTLY UNDERUTILIZED AMONG HOSPITALIZED SMOKERS WITH CORONARY HEART DISEASE Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Current Issues in Cardiovascular Epidemiology, Disparities, and Safety Abstract Category: 32. Prevention: Clinical Presentation Number: 1148-064 Authors: Quinn R. Pack, Aruna Priya, Tara Lagu, Penelope Pekow, Nancy Rigotti, Peter Lindenauer, Baystate Medical Center, Springfield, MA, USA, Massachussetts General Hospital, Boston, MA, USA Background: Smoking cessation (SC) is the single most effective behavior change that patients can make after a hospitalization for coronary heart disease (CHD) to prevent recurrent events. Furthermore, inpatient SC therapy coupled with outpatient follow-up can significantly improve long-term SC rates, but little is known about how often SC therapies are used among hospitalized patients.
Methods: Using billing data and ICD-9 codes from a diverse group of hospitals participating in Premier Inc. database in 2014, we examined how often nicotine replacement (patch, gum, lozenge, inhaler), varenicline, and bupropion were administered to current smokers hospitalized for myocardial infarction (MI), percutaneous coronary intervention, or coronary artery bypass surgery. We also examined rates of professional SC counseling, patient factors associated with use of SC therapies, and trends in hospital rates of SC therapies starting from 2004. Results: At 282 hospitals with ≥ 25 smokers in 2014, we included 36,675 patients (58 ± 9 years, 69% male, 63% with MI.) Overall, 29.9% of patients received at least one kind of SC therapy during the hospitalization. The most common therapy was the nicotine patch (20.4%) at an average daily dose of 19.8 mg, followed by professional counseling (9.6%). Fewer patients received bupropion (2.2%), gum (0.3%), lozenge (0.04%), inhaler (0.2%), or varenicline (0.4%). Smokers with lung disease, depression, alcohol use, and younger age were more likely to receive a SC therapy (p<0.001 for all). Additionally, there was substantial variation in use of SC therapies across hospitals with a median (10th - 90th percentile) treatment rate of 26.2% (11.4% to 51.1%.) Between 2004 and 2014, there was a 10.0 % absolute increase (p <0.001) in the mean rate of SC therapy use across hospitals. Conclusions: In a large sample of smokers with CHD at multiple hospitals, we found that only a minority of patients received any SC therapy and that this percentage has increased only modestly in the past 10 years. Given that hospitalization is usually a teachable moment with high patient motivation to quit smoking, there appears to be a large opportunity for improvement in the care of smokers hospitalized with CHD.