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Smoking cessation counselling ‘inadequate’ measure of AMI care

Arch Intern Med 2008; 168: 2111–2117

Smoking cessation counselling for hospital inpatients with acute myocardial infarction (AMI) does not correlate with actual smoking cessation 1 year later, study results show.

Documentation of smoking cessation counselling (SCC) is currently used as a measure of hospitals’ quality of AMI care. However, the authors of a study in the Archives of Internal Medicine point out that: “Despite its use as a performance measure and quality indicator, the association between hospital performance of the SCC metric and actual rates of subsequent smoking cessation is unknown.”

The US study, led by Gordon Reeves of the Duke University Medical Centre in Durham, North Carolina, analyzed a population of 889 patients who smoked in the year before AMI.

SCC was documented in 72.3% of the patients. Telephone follow-up was performed after discharge, with 76.2% of patients followed up at 1 year.

Patients with documented SCC had a 50.1% rate of quitting at 1 year, compared to 60.7% for patients without documented SCC.

The researchers used a modified Poisson regression model to analyze the association between documented SCC and smoking cessation at 1 year. They found that SCC was associated with a small, but statistically significant, lower rate of quitting at 1 year, with a relative risk of 0.76.

“These findings should not be interpreted to suggest discontinuation of SCC,” the researchers caution, but they suggest that the current hospital performance measure for SCC is inadequate.

“A potentially superior alternative would be to base the performance metric on patient outcomes directly, namely, cessation rates at 6 or 12 months after hospitalization for AMI.”

Read the abstract