Present-Day Efforts to Aid Quit-Smoking Attempts Are Substandard, Says Expert

May 07, 2012

May 7, 2012 (Dublin, Ireland) — Efforts to help patients quit smoking are stuck in the dark ages, and cardiologists should be more engaged with their patients in terms of providing strong, clear, and encouraging advice while offering pharmacotherapy to aid in the quitting process.

These are the conclusions of Dr Andrew Pipe (University of Ottawa Heart Institute, ON), an expert in smoking cessation, delivered last week at EuroPrevent 2012 [1]. During his presentation, Pipe described the "Ottawa Model for Smoking Cessation," a comprehensive program that has boosted successful quitting rates. Importantly, Pipe told the audience that tobacco addiction is the most monumental of the modifiable cardiovascular risk factors but that the clinical approaches to dealing with smokers are "still rooted firmly in the last century and they reflect a unique combination of dogma, misconception, and ignorance.

"Many clinicians, probably the majority, still believe that if we just lecture patients and asked them to get their ducks in a row and become more organized, more responsible, and more self-disciplined, they will stop smoking," said Pipe. "This, of course, is naive in the extreme and fails to understand the distorted neurophysiology that is in the background of this most tenacious of addictions."

Document, treat, and follow up

Presenting data from the Ottawa Model, which identifies and documents the smoking status of all patients who present to the clinic and in turn provides strategic advice for quitting that includes counseling and first-line smoking-cessation medications, Pipe said his clinic has significantly boosted successful quit rates. The program also includes automated follow-up support for six months and additional access to primary care or community programs if needed.

As a consequence of implementing the Ottawa Model, smoking-cessation rates at six and 12 months have increased from 35% to more than 50%. The program has been offered to other hospitals in the region and the success continued, albeit slightly attenuated, in these general hospital settings. The program has since been implemented in more than 120 healthcare facilities across Canada. On the basis of the diminished rates of readmission for cardiovascular events, Pipe said his hospital saves 450 bed-days per year, a number that "reflects a very profound return on our investment."

For programs such as the Ottawa Model, Pipe said that physicians have to let go of some of their "zombie concepts," those being old ways of thinking that always seem to rise from the dead, including concerns that nicotine-replacement therapy can't be started in patients hospitalized for an acute event or that patients are too fragile following a coronary event to endure the psychological and physiological stresses of quitting smoking. At the Ottawa Heart Institute, 70% of smokers hospitalized for an acute coronary syndrome receive nicotine-replacement therapy within hours of their admission.

Pipe said that cardiologists have been less committed to dealing with smoking than they have been with the management of other cardiovascular risk factors, but that they should be providing leadership to the entire medical community in terms of how they address the smoking issue. He added that most smokers know they shouldn't smoke and have failed at previous attempts to quit. Smokers don't need more lectures or more education, he said, but medical help with their quitting efforts, because smoking detracts from any reductions in lipid levels or blood pressure.

"Do not delude yourselves, and do not make assumptions that simply because you are managing hypertension or managing dyslipidemia you are helping your patients to any great degree," said Pipe. "Those patients who are hypertensive and still smoking, even though their hypertension might be controlled, or dyslipidemic and still smoking, even though their dyslipidemia might be controlled, will derive nothing like the benefits most clinicians will assume will occur."

In most hospitals, if patients are recognized as being dyslipidemic, hypertensive, or having impaired renal function, clinicians are "all over these risk factors" but fail to take similar action with regard to smoking. Typically, the response is to recommend the patient talk to their general practitioner about quitting, a response that Pipe says is substandard. Instead, physicians have a fundamental responsibility to make sure that patients are treated as aggressively for their tobacco addiction as they would be if they had any other cardiovascular risk factor.

Pipe disclosed financial compensation from Pfizer, GlaxoSmithKline, and Johnson & Johnson.

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