Smoking cessation advice by rheumatologists: results of an international survey

Naranjo, Antonio; Khan, Nasim A.; Cutolo, Maurizio; Lee, Shin-Seok; Lazovskis, Juris; Laas, Karin; Pandya, Sapan C; Sokka, Tuulikki

doi:10.1093/rheumatology/keu213

Cited by 28 publications

(20 citation statements)

References 14 publications

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“…The risk of all‐cause mortality fell significantly for each year of smoking cessation. This information may be of value to those developing smoking cessation programs for patients with RA 33.…”

Section: Discussionmentioning

confidence: 97%

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Joseph

Movahedi

Dixon

et al. 2016

Arthritis Care & Research

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ObjectiveTo investigate the association between smoking status and smoking cessation with mortality in patients with rheumatoid arthritis (RA).MethodsAn incident cohort of patients with RA was identified using the Clinical Practice Research Datalink, a database of UK primary care electronic medical records. Time‐varying smoking status, years of cessation, and amount smoked were determined from patients' medical records. The date and underlying cause of death were identified by linkage with Office for National Statistics records. The associations between smoking status and smoking cessation with all‐cause and cause‐specific mortality (circulatory disease, all cancers, lung cancer, respiratory disease, and respiratory infection) were investigated using adjusted Cox (all‐cause mortality) and Fine‐Gray (cause‐specific mortality) regression.ResultsThe cohort comprised 5,677 patients (median age 61.4 years, 68% women), with 40% as never smokers, 34% former smokers, and 26% current smokers at baseline. Compared to never smoking, current smoking was associated with an increased risk of all‐cause mortality (hazard ratio 1.98 [95% confidence interval (95% CI) 1.56, 2.53]), and mortality due to circulatory disease (subdistribution hazard ratio [SHR] 1.96 [95% CI 1.33, 2.90]) and lung cancer (SHR 23.2 [95% CI 5.15, 105]). Each year of smoking cessation was associated with a decreased risk of all‐cause mortality (former heavy smokers SHR 0.85 [95% CI 0.77, 0.94], former light smokers SHR 0.90 [95% CI 0.84, 0.97]).ConclusionCurrent smoking is associated with an increased risk of all‐cause, cardiovascular, and lung cancer mortality in patients with RA. Each year of cessation is associated with a reduced risk of all‐cause mortality. This information may prove helpful in smoking cessation programs for patients with RA.

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Section: Discussionmentioning

confidence: 97%

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Joseph

Movahedi

Dixon

et al. 2016

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…These are also cost-effective interventions; in the US quit line services are available free in all 50 states, and Medicare, Medicaid and most insurance plans will cover tobacco cessation therapies. Specifically, a simple “Ask, Advise, Connect” model was 13 times more effective than passive referral using brochures to get smokers to connect with quit lines [84]. Internationally, Naranjo et al highlighted the need for more standardized, clinic- or system-wide interventions for tobacco cessation reporting a lack of a protocol in many rheumatology departments, although 65% of rheumatologists self-reported advising their patients to quit smoking “most or all of the time” [84].…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, a simple “Ask, Advise, Connect” model was 13 times more effective than passive referral using brochures to get smokers to connect with quit lines [84]. Internationally, Naranjo et al highlighted the need for more standardized, clinic- or system-wide interventions for tobacco cessation reporting a lack of a protocol in many rheumatology departments, although 65% of rheumatologists self-reported advising their patients to quit smoking “most or all of the time” [84]. In a prospective study by that group, one out of six RA patients quit smoking after a systematic clinical intervention was established [85].…”

Section: Introductionmentioning

confidence: 99%

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Chodara

Wattiaux²,

Bartels³

2017

Curr Rheumatol Rep

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The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. Purpose of Review By critically reviewing literature published within the past five years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. Recent Findings We examine recent guidelines, recommendations, and evidence, and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. Summary This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

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“…However, very little is known regarding the rate of rheumatologists performing tobacco counseling. Estimates from retrospective physician surveys indicate that only half of rheumatologists self-reported that they provided smoking cessation counseling to the majority of their patients [9]. Moreover, self-reporting may overestimate true counseling rates.…”

Section: Introductionmentioning

confidence: 99%

Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control

Vreede¹,

Johnson²,

Piper³

et al. 2017

J Clin Rheumatol

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Background Among patients with rheumatoid arthritis (RA), smoking increases risk for severe RA and pulmonary and cardiovascular disease (CVD). Despite this, little is known about smoking cessation counseling by rheumatologists. Objectives We examined predictors of tobacco counseling in RA patients who smoke including the effect of perceived RA control. We hypothesized that patients with controlled RA would receive more counseling according to the competing demands model, which explains that preventive care gaps occur as a result of competing provider, patient, and clinic factors. Methods This secondary data analysis involved RA patients with an additional CVD risk factor identified in an academic medical center 2004–2011. Trained abstractors assessed documented smoking counseling and rheumatologists’ impression of RA control in clinic notes. We used multivariable logistic regression to predict having received smoking cessation counseling, including sociodemographics and comorbidity in models. Results We abstracted 3,396 RA visits, including 360 visits (10%) with active smokers. Perceived controlled RA was present in 31% of visits involving smokers (39% in non-smokers). Beyond nurse documentation, providers documented smoking status in 39% of visit notes with smokers, and smoking cessation counseling in 10%. Visits with controlled versus active RA were less likely to include counseling (OR 0.3, CI 0.1–0.97). Counseling was more likely in visits with prevalent cardiovascular, pulmonary, and psychiatric disease, but decreased with obesity. Conclusions Smoking cessation counseling was documented in 10% of visits and was less likely when RA was controlled. Given smoking’s impact on RA and long-term outcomes, systematic cessation counseling efforts are needed.

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Smoking cessation advice by rheumatologists: results of an international survey

Cited by 28 publications

References 14 publications

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control

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