Background: Cigarette smoking is associated with significant morbidity and mortality among patients with cardiovascular disease. Yet, nearly 1 in 6 people in the US continue to smoke. This study sought to determine the prevalence of smoking and smoking cessation education in the BRIDGE post-discharge cardiac transitional care clinic and associated outcomes.
Methods: Chart review was conducted of 133 randomly selected patients who attended their BRIDGE appointment between 2011-2015 and were current smokers. Demographics and outcomes were compared between patients who did and did not have documentation of smoking cessation education at their BRIDGE clinic visit and between those who did and did not quit smoking at 30 and 180 days post-discharge.
Results: At 30 days post-discharge, 32 (24.1%) patients had quit smoking. At 180 days, 8 patients (6.0%) had resumed smoking, but an additional 10 (7.5%) had quit. There were no demographic differences between those who did and did not quit at 30 or 180 days. Further, there were no differences in readmission (21.9% v. 12.9%, p=0.214) or death (0.0% v. 1.0%, p=1.000) rates between patients who did and did not quit at 30 days post-discharge. However, patients who had quit at 180 days were more often readmitted compared to those who had not quit (55.9% v. 25.3%, p=0.001). Of 133 patients, smoking cessation was discussed with 55 (41.4%). Smoking cessation education was provided at similar rates to patients who did and did not quit smoking at 30 and 180 days (30 day, 28.1% v. 45.5%, p=0.081; 180 day, 32.4% v. 44.4%, p=0.217), and there were no demographic differences between these groups. However, those who discussed smoking cessation were more likely to visit the ED within 180 days post-discharge (50.9% v. 26.9%, p=0.005).
Conclusions: A quarter of patients who quit smoking at 30 days post-discharge had resumed smoking at 180 days. Surprisingly, patients who quit smoking had higher readmission rates at 180 days. This study should be repeated with a larger sample size and explore other potential factors influencing these outcomes. For example, documentation of smoking cessation education was far lower than anticipated and may not be representative of actual discussion frequency. Efforts to design better strategies to encourage smoking cessation and reduce relapse are critical.