Spain: Cardiologists Plead Ignorance, Lack of Time, in Helping Smokers Butt out

Source from:  theheart.org (ca)  04/24/2013

Smoking rates in Spain are among the highest in Europe, yet cardiologists surveyed admit they do not always ask their patients about smoking. And when they do, they don't often investigate the level of nicotine dependence or offer pharmaceutical aids for quitting.

Those are some of the insights from a survey conducted by Dr Regina Dalmau (Hospital La Paz, Madrid, Spain) and colleagues, presented here at EuroPrevent 2013.

"If you have an infarction and you are a smoker, and you quit smoking, your mortality [risk] would be reduced by 36%," Dalmau told heartwire. "If you use statins after an AMI, your mortality [risk] is reduced by 30%. So smoking cessation is actually more effective, but it is something we [cardiologists] don't always do. So many patients keep on smoking because no one, or very few, have told them to stop."

Dalmau and colleagues emailed their survey, which permitted anonymous answers and had no financial component, to 3000 cardiologist members of the Spanish Society of Cardiology. Only 328 (11%) responded, which means the results likely represent the "best-case" scenario, Dalmau conceded.

The average age of the respondents was 44, 63% were male, 76% were clinical cardiologists, 18% were interventional cardiologists, 29% were past smokers, and 4% were current smokers.

As for how cardiologists managed smoking cessation among their patients, only three out of four cardiologists said they would ask their patients about their smoking at every visit, and just 73% said they charted the information. The bulk of respondents estimated that 20% to 30% of their patients were current smokers and that the same percentage relapsed after an AMI.

And while 76% of cardiologists said they always recommended smoking cessation, only 40% would set up follow-up visits to assess any progress with quitting.

In other key details:
•Only 22% said they'd have quitting brochures available at their practices.
•Only 14% have a CO-oximeter.
•22% had never heard of the Fagerström test used to gauge level of nicotine dependence.
•60% considered their training in smoking cessation to be insufficient.
•71% said they wished they could improve their skills in helping patients quit.

Dalmau and colleagues also asked physicians about their use of prescription drugs. The vast majority of cardiologists said they had not prescribed any smoking-cessation drugs or nicotine replacement in the last month. By far, the most commonly stated reason for not prescribing medications was lack of familiarity with the drugs (73%), followed by safety concerns (11%).

To heartwire, Dalmau stressed that physicians were clear that they wanted to do more for patients but admitted to being uninformed about the treatment options.

"I think the real reason is that they are not trained," she said. "You need to be able to talk to the patient, to communicate, and cardiologists don't like to communicate, they prefer to prescribe pills and order tests," she said. "It's true that cardiologists are more attracted by techniques and devices, yet there is really a need for [better smoking-cessation interventions] in improving the prognosis of the patients."

Lack of time, cited by 5% of cardiologists, is also a big problem. "The more time you dedicate to this, the more likely you are to get success."

And while more people are smoking in Spain than in other parts of the world, Dalmau believes that the reticence among cardiologists is likely more universal and extends to general practitioners as well. For all physicians, she said, "better education is key." Enditem