While nonsmoking patients hospitalized with coronary heart disease (CHD) reported secondhand tobacco smoke (SHS) exposure in the days before their hospital admission, only 17.3 percent of patients recalled a physician or nurse asking them about their SHS exposure despite evidence that SHS increases nonsmokers' risk of cardiovascular disease, according to a report published online by JAMA Internal Medicine.
SHS exposure also is associated with a higher likelihood of subsequent cardiovascular and all-cause mortality as well as another heart attack, according to background in the research letter.
Sandra J. Japuntich, Ph.D., of the Veterans Affairs Boston Healthcare System, who conducted the research while at the Massachusetts General Hospital, Boston, and colleagues enrolled 214 patients in a study after they were admitted to a hospital with ischemic CHD and reported no tobacco or nicotine replacement use. Patients were interviewed about their SHS exposure at home, work and in their car, as well as their beliefs about the risks of SHS and any interventions by health care professionals since being admitted to the hospital regarding SHS exposure.
The study results indicate that 47 patients (22 percent) reported SHS in the 30 days before hospital admission and 33 patients (15.4 percent) reported SHS in the seven days before admission. Nearly 14 percent of the patients (n=29) lived with a smoker. Analyses of detectable cotinine found that among 184 individuals with sufficient samples, 15 (8.2 percent) had detectable cotinine (greater than or equal to 0.020 ng/mL) and among 72 saliva samples analyzed with a more sensitive test, 29 (40.3 percent) had detectable cotinine (greater than or equal to 0.05 ng/mL). The also study found that most patients (89.7 percent) believed SHS was harmful to the health of nonsmokers, but only 37 patients (17.3 percent) recalled being asked about their SHS exposure since being admitted to the hospital.
"The findings of this study make a strong case for the need to address SHS exposure more effectively in inpatient cardiology practice," the research letter concludes.
Commentary: Learning to Act on 2nd-Hand Smoke Exposure
In a related commentary, R. William Vandivier, M.D., of the University of Colorado, Department of Medicine, Aurora, writes: "This study is important because it clearly demonstrates where the health care community has failed to translate research into action. ... Regardless of the method used to stimulate counseling by health care providers, the present study emphasizes the need to allocate energy and resources to uncover the effects of SHS exposure and learn how to maximally implement these findings in patients to improve their health."