2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment

Barua, Rajat S.; Rigotti, Nancy A.; Benowitz, Neal L.; Cummings, K. Michael; Jazayeri, Mohammad; Morris, Pamela B.; Ratchford, Elizabeth V; Sarna, Linda; Stecker, Eric C.; Wiggins, Barbara S.

doi:10.1016/j.jacc.2018.10.027

Cited by 250 publications

(155 citation statements)

References 144 publications

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“…Likewise, assessing patients and assisting in their quit attempt must be universal, rather than selective, and tailored to the patient's interests and needs. 27 The primary limitation of this study is that our sample size was small and limited to only English-speaking patients. In addition, this study was performed at a single center in western Massachusetts, therefore, our results may not uniformly apply to other institutions, clinical settings, and/or patient populations.…”

Section: Rather Meta-analyses Show That the Most Successful Intervenmentioning

confidence: 98%

“…26 Considering the uncertainty surrounding the efficacy and safety of e-cigarettes, FDA approved SCM, such as NRT, Varenicline, and Bupropion, should be encouraged as first-line pharmacotherapy treatment options. 27 Considering that SC counseling rates vary widely from 17% to 81% and pharmacotherapy administration rates during hospitalization are low, 28 it appears that physicians are not capitalizing on key opportunities to assist their patients in quitting smoking. Previous research indicates that, although providers recognize the benefits of SCM/NRT, they are reluctant to implement these treatments due to lack of knowledge and prescribing experience, concerns surrounding the financial implication of providing NRT to patients, and the possibility of liability and legal implications.…”

Section: Rather Meta-analyses Show That the Most Successful Intervenmentioning

confidence: 99%

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Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

Riley

Ainani

Turk

et al. 2019

Clinical Cardiology

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Background Prioritizing and managing multiple behavior changes following a cardiac hospitalization can be difficult, particularly among smokers who must also overcome a serious addiction. Hypothesis Hospitalized smokers will report a strong interest in smoking cessation (SC) but will receive little assistance from their physicians. Methods We asked current smokers hospitalized for an acute cardiac event to prioritize their health behavior priorities, and inquired about their attitude toward SC therapies. We also assessed SC cessation prescriptions provided by their physicians. Results Of the 105 patients approached, 81 (77%) completed the survey. Of these, 72.5% ranked SC as their greatest health change priority, surpassing all other behavior changes, including: taking medications, attending cardiac rehabilitation (CR), dieting, losing weight, and attending doctor appointments. Patients felt that SCM (44%), CR (41%), and starting exercise (35%) would increase their likelihood for SC. While most patients agreed that smoking was harmful, 16% strongly disagreed that smoking was related to their hospitalization. At discharge, medication was prescribed to ~32% of patients, with equal frequency among patients who reported interest and those who reported no interest in using medications. Conclusion The majority of hospitalized smokers with cardiac disease want to quit smoking, desire help in doing so, and overwhelmingly rate cessation as their highest health behavior priority, although some believe smoking is unrelated to their disease. The period following an acute cardiac event appears to be a time of great receptivity to SC interventions; however, rates of providing tailored, evidence‐based interventions are disappointingly low.

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Section: Rather Meta-analyses Show That the Most Successful Intervenmentioning

confidence: 98%

Section: Rather Meta-analyses Show That the Most Successful Intervenmentioning

confidence: 99%

Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

Riley

Ainani

Turk

et al. 2019

Clinical Cardiology

View full text Add to dashboard Cite

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“…The 2020 Report of the Surgeon General, along with clinical practice guidelines from the United States Preventive Services Task Force, United States Public Health Service, and the American College of Cardiology all highlight the importance of behavioral intervention for tobacco treatment in addition to pharmacotherapy. 13,14 Key aspects of a tobacco treatment appointment are education about nicotine withdrawal symptoms and behavioral interventions. Behavioral intervention techniques include cognitive behavioral strategies (stimulus control, stress reduction, avoidance, delay tactics, reframing) and motivational interviewing that is based on theories of behavior change (health belief model, transtheoretical model, social cognitive/learning theory).…”

Section: Behavioral Interventionmentioning

confidence: 99%

Coronavirus Disease 2019 and Smoking

Lang¹,

Yakhkind

2020

Chest

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Smoking is associated with one of five deaths in the United States. Multimodality tobacco treatment increases rates of successful cessation by at least 20%. The coronavirus disease 2019 pandemic has put a halt to many inpatient and outpatient medical visits that have been deemed nonessential, including tobacco treatment. The transition to telehealth has been wrought with challenges. Although data on the association between coronavirus disease 2019 and tobacco products are mixed, the overall health consequences of tobacco point towards increased risk of morbidity and death that is associated with the virus. This leaves smoking as one of the few readily modifiable risk factors in an environment understandably not set up to prioritize cessation. A military health facility on Fort Eustis in Virginia runs a successful tobacco treatment program and adapted it to pandemic times. This article describes the process and lessons learned from this initiative. The model is applicable and scalable to government and civilian health centers as health care adapts to a new normal.

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“…Clinical guidelines urge health care providers to address tobacco use with all hospitalized patients who use tobacco (4)(5)(6). A robust body of evidence demonstrates that smoking cessation counseling interventions that begin in the hospital and continue for at least 1 month after discharge are effective, increasing smoking cessation rates by 37% at 6 months after discharge in a meta-analysis of 50 controlled trials, with additional benefit when NRT is added to counseling (2).…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping Hand 4 randomized controlled trial

Rigotti

Schnitzer

Davis

et al. 2020

Preprint

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Background. Tobacco smoking remains the leading preventable cause of death in the U.S. A hospital admission provides smokers with a unique opportunity to stop smoking because it requires temporary tobacco abstinence while illness may enhance motivation to quit. Hospital interventions must continue post-discharge to increase tobacco abstinence long-term, but how best to accomplish this remains unclear. Building on two previous randomized controlled trials, each of which tested smoking cessation interventions that began in hospital and continued after discharge, this trial compares two interventions that provide sustained smoking cessation treatment after hospital discharge with the goal of improving long-term smoking cessation rates among hospitalized smokers.Methods. Helping Hand 4 is a three-site randomized controlled trial that compares the effectiveness of two active interventions for producing validated past 7-day tobacco abstinence 6 months after hospital discharge. Smokers who are admitted to three hospitals receive a standard in-hospital smoking intervention, and plan to quit smoking after discharge are recruited and randomly assigned to two interventions that begin at discharge, Personalized Tobacco Care Management (PTCM) or Quitline eReferral. Each lasts 3 months. At discharge, PTCM provides 8 weeks of free nicotine replacement (NRT; a participant’s choice of patch, gum, lozenge, or a combination) and then proactive smoking cessation support using an automated communication platform and live contact with a tobacco treatment specialist who is based in the health care system. In the eReferral condition, a direct referral is made from the hospital electronic health record to a community-based resource, the state’s telephone quitline. The quitline provides up to 8 weeks of free NRT and offers behavioral support via a series of phone calls from a trained coach. Outcomes are assessed at 1, 3, and 6 months after discharge. The study hypothesis is that PTCM will produce higher quit rates than eReferral.Discussion. HH4 is a pragmatic trial that aims to evaluate interventions in real-world conditions. This project will give hospital systems critical evidence-based tools for meeting National Hospital Quality Measures for tobacco treatment and maximizing their ability to improve cessation rates and overall health for the millions of smokers hospitalized annually in the U.S.Registration: Prospectively registered prior to start of enrollment at Clinicaltrials.gov # NCT03603496 (July 27, 2018)https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00084MJ&selectaction=Edit&uid=U00002G7&ts=2&cx=ff0oxn

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2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment

Cited by 250 publications

References 144 publications

Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

Coronavirus Disease 2019 and Smoking

Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping Hand 4 randomized controlled trial

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