Smokers hospitalized for heart attacks often don't get cessation drugs

(Reuters Health) - Few smokers hospitalized for heart attacks and other serious complications of cardiac disease get medication to help them quit smoking, a U.S. study suggests.

Researchers examined data on almost 37,000 smokers hospitalized with heart disease and found only about 8,300, or 23%, received a prescription for a smoking-cessation aid during their hospital stay.

“Smoking is a very tough addiction to cure and is the leading cause of preventable death in the U.S.,” lead study author Dr. Quinn Pack of Baystate Medical Center in Springfield, Massachusetts, told Reuters Health by email.

“Hospitalizations are excellent opportunities for change,” he said, because hospitalized patients are highly motivated to improve their health, and so “a little extra support in the form of smoking cessation (drugs) could go a long way.”

Some previous research suggests that smoking-cessation therapy in the hospital followed by additional help afterwards can significantly improve the odds that a quitting attempt will succeed, researchers note in JAMA Internal Medicine, online August 21.

In the current study, however, researchers found wide variation in how often hospitalized patients got cessation help.

At one hospital, for example, smoking cessation aids were prescribed in 64% of cases, the study found.

But at more than 40% of hospitals, fewer than 20% of eligible patients received smoking-cessation medications.

Hospitalized patients were more likely to get help quitting if they also had chronic lung disease or an alcohol abuse problem.

White people in the study were also more likely to receive cessation aids than people of color. Prescriptions were also more common for patients insured by Medicaid than for people with other types of health benefits.

When patients did get help, the nicotine patch was the most commonly used option.

Study participants were 68 years old on average, most were male, and most were hospitalized for a heart attack.

The study wasn’t a controlled experiment designed to prove whether or how prescribing cessation aids in the hospital might improve the odds that patients actually quit.

Still, the findings highlight a missed opportunity to help people quit, said Judith Prochaska, a researcher at Stanford University in California and president of the Society for Research on Nicotine and Tobacco.

“Despite the known harms of smoking, treatment of tobacco is not a standard of care for many U.S. hospitals,” Prochaska, who wasn’t involved in the study, said by email.

Patients should speak up if cessation help isn’t offered, and they should seek out support groups or psychotherapy in addition to prescription medications, said Jean-Francois Etter, a researcher at the University of Geneva in Switzerland who wasn’t involved in the study.

“There is strong evidence that smoking cessation support combined with a smoking cessation prescription is both effective and very cost-effective,” Etter said by email.

It’s possible, however, that some physicians may not want to add smoking-cessation drugs on top of other treatments patients are already getting in the hospital, or because the decision is left to a counselor who isn’t comfortable prescribing smoking-cessation drugs for heart patients, said Dr. Neal Benowitz, chief of clinical pharmacology at the University of California San Francisco.

“Patients should understand that smoking-cessation medications are safe for cardiac patients,” Benowitz, who wasn’t involved in the study, said by email. “Quitting smoking is the single most important thing a smoker can do to improve cardiovascular health.”

In particular, there’s a small risk of an increased heart rate and elevated blood pressure with nicotine-cessation aids like the patch, gum and lozenges, said Dr. James Davis, medical director of the Duke Center for Smoking Cessation in Durham, North Carolina.

“There is good evidence now, however, to support the use of nicotine replacement in hospitalized cardiac patients,” Davis, who wasn’t involved in the study, said by email. “In short, the risk of smoking is so high that most experts feel that the very small risks of using nicotine replacement is simply worth it because it helps smokers quit smoking.”


JAMA Int Med 2017.