Evidence is not enough to change health behaviors

Tobacco use continues to be a major cause of avoidable death, and costs the U.S. health care system billions of dollars per year. However, elderly heart attack survivors rarely filled their prescriptions for smoking cessation drugs upon discharge from the hospital, despite counseling from hospital staff on the need to quit, according to a study presented at the American Heart Association’s most recent annual meeting.

The study evaluated nearly 2,400 heart attack survivors over the age of 65 who were current or recent smokers. Almost all of the patients in the study received prescriptions for smoking cessation medicines before discharge.

However, only about 10 percent of patients actually filled a prescription for the smoking-cessation drugs bupropion (GlaxoSmithKline’s Wellbutrin) or varenicline (Pfizer’s Chantix) within 90 days of discharge from the hospital.

The rate also did not change much over time: At one year post-discharge, only 13 percent filled a prescription for these drugs.

“There remains a great deal of room for improvement in intensifying smoking cessation interventions during and after a patient’s hospital stay for a heart attack,” the researchers, led by Duke University’s Neha Pagidipati, MD, said in a press release.

“These findings come as no surprise for geriatricians and health care professionals who face on a daily basis the challenges of recognizing and managing the complexity of caring for older adults,” Dr. Gisele Wolf-Klein, director of geriatric education, Northwell Health (Great Neck, NY) said in an article in HealthDay News.

Elderly patients face many challenges, such as “multiple medical conditions, which often include depression and forgetfulness,” which can make it more challenging for them to initiate and adhere to a smoking cessation regimen, she said.

Although she agreed with the researchers that more needs to be done during their hospital stay to help patients quit smoking, she said there are reasons patients fail to use smoking-cessation products.

For example, “older adults are particularly concerned with taking too many medications, both because of the increasing and often unsurmountable monthly costs of their prescribed drug regimen, and because of the difficulty of remembering when to take them,” she said.

Too often, patients are simply handed the medications without much explanation; “before buying into” smoking-cessation treatment, “older adults will need strong scientific data to persuade them – and their caregivers – of the longevity and quality of life benefits of giving up one of their last pleasurable habits,” she said.

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital, New York City, agreed that “we clearly have a long way to go in continued long-term counseling” for elderly heart patients who smoke. “We need to enhance our smoking-cessation counseling outside of the hospital by providing additional assistance and education to our patients,” Bhusri said. “The importance of not smoking after a heart attack is crucial to recovery and prevention of future heart attacks.”

This study highlights the challenges inherent in changing behaviors that impact health. The evidence is clear – elderly heart attack patients should stop smoking; however, this will require behavior change on the part of both the physician (in terms of coaching patients) and patients (in terms of adhering to prescribed regimens).