Secondhand smoke exposure counseling may be insufficient amongst cardiology inpatients

1. Amongst non-smoking patients with coronary heart disease (CHD) admitted to the inpatient cardiology service, nearly one-half of the tested patients had evidence of a nicotine metabolite, suggesting exposure to secondhand smoke (SHS). However, less than one-fifth of the participants were actually asked about their secondhand smoke exposure history by a health care professional.

2. Although most patients agreed that SHS was dangerous to their health, there is still a significant opportunity for clinicians to address the dangers of SHS in the inpatient cardiology service.

Evidence Rating Level: 2 (Good)

Study Rundown: Second-hand smoke (SHS) is a risk factor for developing cardiovascular disease and poses a significant risk to those who have preexisting coronary heart disease (CHD). Patients admitted to the hospital with acute coronary syndrome are at higher risk for re-infarction if they are exposed to SHS after discharge. This study, which took place at the inpatient cardiology unit of Massachusetts General Hospital, was conducted to determine the opinions and medical counseling related to SHS amongst non-smoking, CHD patients. The results suggest that while close to one-half of the tested patients had evidence of a nicotine metabolite, suggesting exposure to SHS, less than one-fifth of the participants were actually asked about their SHS exposure history by a health care professional. Although most patients agreed that SHS was dangerous to their health, there is still a significant opportunity for clinicians to address the dangers of SHS in the inpatient cardiology service.

The strength of the study is the specificity of the question asked, which allowed for a simple design to be effective. However, the results are not necessarily generalizable since only one unit of a hospital was included in the study. Rather, this study allows for future investigation of this question in a larger setting.

Click to read the study, published today in JAMA Internal Medicine

Click to read an invited commentary in JAMA Internal Medicine

Relevant Reading: Cotinine-assessed second-hand smoke exposure and risk of cardiovascular disease in older adults

In-Depth [cross-sectional]: The study was conducted at Massachusetts General Hospital. Inclusion criteria were adults in the inpatient cardiology service with a diagnosis of CHD on admission, no history of tobacco or nicotine use, and a stay of less than 48 hours. Eligible participants underwent a thorough demographics interview and had a saliva sample collected for assessing presence of cotinine, a nicotine metabolite that has a 16-hour half-life.

Between May 2010 and January 2011, 214 individuals participated in the study. While using the sensitive cotinine assay, 40.3% of the 72 samples tested were positive. Almost all of the patients (89.7%) believed that SHS was harmful and more than half (56.5%) believed that SHS increased non-smokers’ risk of a heart attack. However, only 17.3% remembered being asked by a clinician about their SHS exposure history.

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