Outcomes of a Smoking Cessation Clinic in Cardiology Services, Vancouver, Canada

BACKGROUND: Adults who have experienced cardiac events have a high burden of smoking and are likely to continue post cardiac event. Research in this population suggests that smoking cessation services offered to this population can reduce the re-occurrence of cardiac events by assisting patients in cessation. However, few cardiology clinics offer smoking cessation services and few cardiologists refer patients to such services. The Smoking Cessation Clinic (SCC) provides evidence-based smoking cessation treatment within Cardiology services in Vancouver General Hospital in Vancouver, Canada. The aim of this study was to evaluate the SCC program in terms of its program engagement and smoking cessation/reduction outcomes. METHODS: This observational study employed a retrospective chart review to examine pilot smoking cessation/reduction outcomes among individuals (N=115) attending the SCC within a two-year period. Within the two-year pilot review period, 81.7% (94/115) of participants engaged in the treatment. Information collected from participant charts included demographics (gender, age, source of income) tobacco use (number of cigarettes smoked per day, age at smoking initiation) and cessation (evidence based modalities used to quit in the past, length of time abstinent at last quit attempt) history, motivation to quit (confidence and importance of quitting, stage of change), nicotine dependence (based on Fagerstrom Test for Nicotine Dependence), psychiatric and medical co-morbidities, and expired carbon monoxide level (exp CO level). The main outcome was smoking cessation based on 7-day point prevalence of abstinence (verified by CO \u3c 8 parts per million and/or self-report) at the end of treatment. A secondary aim was smoking reduction defined as reduction to 50% or less of baseline cigarette consumption. RESULTS: Among engagers, 36.2% (34/94) successfully achieved smoking cessation and 41.7% (25/60) of those who did not achieve cessation reduced their consumption. Significant multivariate predictors of program engagement included older age (OR=1.0, 95% CI=1.0-1.1), greater importance of quitting (OR=1.3, 95% CI=1.1-1.6), and a greater number of medical co-morbidities (OR=1.7, 95% CI=1.0-3.0). Significant multivariate predictors of successfully achieving cessation included being male (OR=3, 95% CI=1.0-13.6) and spending a longer duration (in weeks) in the program (OR=1.1, 95% CI=.71.0-1.1). CONCLUSIONS: Despite the inherent limitations of this retrospective analysis, the modest smoking cessation and reduction outcomes from this pilot study suggest that providing individualized, evidence-based tobacco treatment services is well received by patients in cardiology services. Such smoking cessation interventions can aid in reducing the high burden of tobacco use and related disease among individuals with cardiac co-morbidities