Background: Smoking is an independent and modifiable risk factor for atherosclerotic cardiovascular disease. Recent studies have shown a concerning deficit in the assistance provided to smokers by cardiologists. We assessed practice-level variation, and predictors of smoking cessation assistance (counseling or pharmacotherapy) in the NCDR PINNACLE registry.
Methods: Among 259845 current smokers seen between 1/1/2013 and 12/31/2016 in 348 PINNACLE cardiology practices, we measured the rates of smoking cessation assistance. We used multivariable hierarchical logistic regression models to determine patient and practice predictors of cessation assistance. We measured the practice variation in cessation assistance using a median rate ratio (MRR; the likelihood that the same patient would receive the same assistance at any given practice; >1.2 suggests significant variation).
Results: Cessation assistance was provided to 90790 (35%) smokers. In multivariable models, physician provider (Odds Ratio, OR 1.17 [95% CI 1.12 - 1.22] vs. advanced practice providers), female sex (OR 1.12 [95% CI 1.09 - 1.16]), hypertension (OR 1.33 [95% CI 1.30 - 1.36]), dyslipidemia (OR 1.49 [95% CI 1.46 - 1.53]), coronary artery disease (OR 1.30 [95% CI 1.27 - 1.34]), and peripheral arterial disease (OR 1.68 [95% CI 1.63 - 1.73]) were independently associated with smoking cessation assistance. In contrast, practice location in South Census region (OR 0.36 [95% CI 0.18 - 0.75] vs. West region), older age (OR 0.90 [95% CI 0.89 - 0.91] per 10 year increase), diabetes (OR 0.86 [95% CI 0.83 - 0.88]), and atrial fibrillation (OR 0.95 [95% CI 0.92 - 0.97]) were associated with less cessation assistance. Finally, there was a large variation in practice rates of cessation assistance (MRR: 5.52 [95% CI 4.78 - 6.48]), even after adjustment for patient and practice characteristics.
Conclusions: In a national ambulatory cardiology practice registry, only one in 3 smokers received cessation assistance. We identified the practice and patient-level predictors of smoking cessation assistance, however, these predictors minimally accounted for the large practice-level variation in cessation assistance. Efforts are needed to address these gaps and reduce variation in cessation assistance.