Smoking Cessation: An Ongoing Challenge

Smoking cessation activities to use with patientsResearch has shown the benefits of smoking cessation in reducing cardiovascular events, overall mortality, post-myocardial infarction mortality, stroke, aortic disease and peripheral vascular disease.1 However, in a CardioSurve survey of 146 cardiologists, more than one-third (37%) note that smoking cessation remains a primary challenge to patient self-care and treatment.

According to the survey results, nearly all cardiologists (94%) personally advise patients who smoke to quit smoking and most cardiologists (85%) asses if a smoker is interested in quitting. When it comes to assisting patients with cessation, 69% say they are comfortable referring patients to a smoking cessation program. Only half provide pharmacologic therapy (53%) or nicotine replacement therapy (51%), while even fewer (42%) arrange a follow-up with a health care provider or smoking cessation program.

While there are many barriers to implementing smoking cessation in patients, 74% of clinicians say that the biggest barrier is that patients are simply not motivated to stop smoking. “My biggest problem with smoking cessation is that in this current era patients are well aware of the harms of tobacco usage, but still have little motivation to quit,” one cardiologist writes. Time constraints on physicians are also an issue – 46% cite a lack of time to engage in smoking cessation related activities and 36% cite a lack of time for clinic or hospital care teams to do the same.

However, most cardiologists are interested in becoming better equipped to help their patients quit smoking. More than 4 out of 5 clinicians (82%) note that patient education materials on cessation strategies, use of nicotine replacement therapy, pharmacotherapy, and the effectiveness of counseling support would be useful in their practices. While more than half (56%) believe that they have an adequate understanding of current cessation guidelines for counseling, prescribing nicotine replacement therapy or pharmacotherapy, and tobacco cessation follow-up, 75% of cardiologists are interested in learning more about effective strategies to assist their patients in successful tobacco cessation. Additionally, 53% believe they would be more motivated to engage in cessation counseling if adequate reimbursement was available.

Cardiologist evaluation of smoking cessation related topicsIn terms of ACC offerings that would be helpful to practices, three out of four cardiologists note that online patient- education resources such as “Stop Smoking” provided by the College’s patient-focused website,, would be useful for improving the quality of their smoking cessation services. Additionally, half of cardiologists would consider a systematic review of evidence and ACC guidelines on tobacco cessation counseling, quit programs, smoke-free legislation and policies, and nicotine replacement therapy or pharmacotherapy helpful to them as well.

Given that population health is a strategic priority of the ACC, programs and tools to aid in smoking cessation will continue to play a big role in the prevention of cardiovascular disease. As another cardiologist notes, “I think this is an extremely important topic that can have a profound effect on our patients but also on others that have 2nd and 3rd hand smoke contact. Health outcomes can significantly improve if we are able to better manage this problem.”

For smoking cessation resources for patients, visit

1. Hermanson B., Omenn G.S., Kronmal R.A., et al; Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease. Results from the CASS registry. N Engl J Med. 1988; 319:1365-1369.

Clinical Topics: Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Smoking

Keywords: ACC Publications, Myocardial Infarction, Nicotine, Aortic Diseases, Motivation, Peripheral Vascular Diseases, Smoking, Smoking Cessation, Stroke, Tobacco Use, Tobacco Use Disorder

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