1
|
Pleym K, Dammen T, Wedon-Fekjaer H, Husebye E, Sverre E, Tonstad S, Munkhaugen J. A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: a randomized trial. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae028. [PMID: 38666249 PMCID: PMC11044967 DOI: 10.1093/ehjopen/oeae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Aims To evaluate the effects of a multi-component intervention for smokers hospitalized for atherosclerotic cardiovascular disease (ASCVD) on the participation rate in community-based cessation programmes and the use of cessation drugs. Additionally, to explore the impact on the cessation rates at 6 months. Methods and results A randomized parallel-group study was conducted at a Norwegian secondary care hospital in 2021. The intervention group was: (i) counselled using motivational interviewing techniques during hospitalization; (ii) given an information leaflet, detailing the cessation programme; and (iii) referred to the community-based smoking cessation treatment including a post-discharge pro-active telephone invitation. The control group received usual care and the same information leaflet containing clear contact details for initiating participation. Data were collected at baseline, 1, 3, and 6 months. Among 99 smokers hospitalized with ASCVD, 40 were excluded. Of 59 randomized patients, 4 were lost to follow-up and 55 completed the study. The mean age was 65.1 (standard deviation 9.3) years, 35% were female, and 88% had smoked >20 years. Co-morbidity was prevalent (mean Charlson score 4.8). The intervention group was more likely to participate in the smoking cessation treatment {48 vs. 7%, difference: 41% [95% confidence interval (CI): 14%, 63%]} and used cessation drugs more frequently [59 vs. 21%, difference: 38% (95% CI: 17%, 59%)]. At the 6 months point prevalence, we observed notable between-group differences in self-reported cessation rate (48 vs. 25%). Conclusion The intervention significantly increased the participation rate at community-based smoking cessation programmes and the use of cessation drugs among multi-morbid smokers hospitalized for ASCVD.
Collapse
Affiliation(s)
- Karin Pleym
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Toril Dammen
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Sognsvannsveien 2, 0372 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway
| | - Harald Wedon-Fekjaer
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Trondheimsveien 235, 0586 Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| |
Collapse
|
2
|
Laranjo L, Lanas F, Sun MC, Chen DA, Hynes L, Imran TF, Kazi DS, Kengne AP, Komiyama M, Kuwabara M, Lim J, Perel P, Piñeiro DJ, Ponte-Negretti CI, Séverin T, Thompson DR, Tokgözoğlu L, Yan LL, Chow CK. World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update. Glob Heart 2024; 19:8. [PMID: 38273995 PMCID: PMC10809857 DOI: 10.5334/gh.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/27/2024] Open
Abstract
Background Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper. Results Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.
Collapse
Affiliation(s)
- Liliana Laranjo
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Marie Chan Sun
- Department of Medicine, University of Mauritius, Réduit, Mauritius
| | | | - Lisa Hynes
- Croí, the West of Ireland Cardiac & Stroke Foundation, Galway, Ireland
| | - Tasnim F. Imran
- Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, US
| | - Dhruv S. Kazi
- Department of Medicine (Cardiology), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, US
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Jeremy Lim
- Global Health Dpt, National University of Singapore Saw Swee Hock School of Public Health, Singapore
| | - Pablo Perel
- Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine and World Heart Federation, London, UK
| | | | | | | | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, United Kingdom
- European Association of Preventive Cardiology, Sophia Antipolis, UK
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
| | - Clara K. Chow
- Faculty of Medicina and Health, Westmead Applied Research Centre, University of Sydney, Australia
| |
Collapse
|
3
|
Robijn AL, Filion KB, Woodward M, Hsu B, Chow CK, Pearson SA, Jorm L, Falster MO, Havard A. Comparative effect of varenicline and nicotine patches on preventing repeat cardiovascular events. Heart 2023; 109:1016-1024. [PMID: 36878673 DOI: 10.1136/heartjnl-2022-322170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To determine the comparative effectiveness of postdischarge use of varenicline versus prescription nicotine replacement therapy (NRT) patches for the prevention of recurrent cardiovascular events and mortality and whether this association differs by sex. METHODS Our cohort study used routinely collected hospital, pharmaceutical dispensing and mortality data for residents of New South Wales, Australia. We included patients hospitalised for a major cardiovascular event or procedure 2011-2017, who were dispensed varenicline or prescription NRT patches within 90day postdischarge. Exposure was defined using an approach analogous to intention to treat. Using inverse probability of treatment weighting with propensity scores to account for confounding, we estimated adjusted HRs for major cardiovascular events (MACEs), overall and by sex. We fitted an additional model with a sex-treatment interaction term to determine if treatment effects differed between males and females. RESULTS Our cohort of 844 varenicline users (72% male, 75% <65 years) and 2446 prescription NRT patch users (67% male, 65% <65 years) were followed for a median of 2.93 years and 2.34 years, respectively. After weighting, there was no difference in risk of MACE for varenicline relative to prescription NRT patches (aHR 0.99, 95% CI 0.82 to 1.19). We found no difference (interaction p=0.098) between males (aHR 0.92, 95% CI 0.73 to 1.16) and females (aHR 1.30, 95% CI 0.92 to 1.84), although the effect among females deviated from the null. CONCLUSION We found no difference between varenicline and prescription NRT patches in the risk of recurrent MACE. These results should be considered when determining the most appropriate choice of smoking cessation pharmacotherapy.
Collapse
Affiliation(s)
- Annelies L Robijn
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mark Woodward
- The George Institute for Global Health, UNSW Sydney, Camperdown, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Benjumin Hsu
- Centre for Big Data Research in Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sallie-Anne Pearson
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Michael O Falster
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Raspe M, Bals R, Bölükbas S, Faber G, Krabbe B, Landmesser U, Al Najem S, Przibille O, Raupach T, Rupp A, Rustler C, Tuffman A, Urlbauer M, Voigtländer T, Andreas S. [Smoking cessation in hospitalised patients - Initiate among inpatients, continue when outpatients - A Position Paper by the German Respiratory Society (DGP) Taskforce for Smoking Cessation]. Pneumologie 2023. [PMID: 37186277 DOI: 10.1055/a-2071-8900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a "teachable moment" for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 "Multimodal inpatient treatment for smoking cessation" and the establishment of quality contracts according to § 110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs.
Collapse
Affiliation(s)
- Matthias Raspe
- Charité - Universitätsmedizin Berlin, Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und des Berlin Institute of Health, Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin, Berlin
| | - Robert Bals
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Serve Bölükbas
- Klinik für Thoraxchirurgie, Universitätsmedizin Essen - Ruhrlandklinik, Essen
| | - Gerhard Faber
- CELENUS Teufelsbad Fachklinik Blankenburg, Blankenburg
| | - Bernd Krabbe
- Herz-Kreislaufmedizin/Angiologie, UKM Marienhospital Steinfurt, Steinfurt
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin
- DZHK (German Centre for Cardiovascular Research), partner site Berlin
| | | | | | - Tobias Raupach
- Universitätsklinikum Bonn (AÖR), Institut für Medizindidaktik, Bonn
| | | | - Christa Rustler
- Deutsches Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen DNRfK e. V., Berlin
| | - Amanda Tuffman
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Standort Innenstadt, München, außerdem Deutsches Zentrum für Lungenforschung
| | - Matthias Urlbauer
- Medizinische Klinik 3 (Schwerpunkt Pneumologie) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - Thomas Voigtländer
- Deutsche Herzstiftung e. V., Frankfurt
- MVZ CCB Frankfurt und Main-Taunus, Frankfurt
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, außerdem Abteilung Kardiologie und Pneumologie der Universitätsmedizin Göttingen und Deutsches Zentrum für Lungenforschung
| |
Collapse
|