ACC's new 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment provides a comprehensive and structured approach to evaluating and treating tobacco dependence. Published Dec. 5 in the Journal of the American College of Cardiology, the document also offers practical guidance for overcoming challenges commonly encountered in the clinical practice setting.

The pathway focuses on the assessment of cigarette smoking, nicotine dependence, and other forms of combustible tobacco products – such as cigars, cigarillos, pipe tobacco and hookah – in adults. It also places an emphasis on individuals with cardiovascular disease. The delivery of behavioral, pharmacological and supportive interventions in both the inpatient and outpatient settings, second hand smoke exposure, and alternative tobacco products – such as electronic cigarettes – are also discussed.

Rajat S. Barua, MD, PhD, FACC, chair of the writing committee, et al., emphasize the need for a team-based system of care to ensure all patients are asked about cigarette smoking and other tobacco product use at all clinical encounters. "The reversable relationship between cigarette smoking and cardiovascular disease events provides a strong rationale for health care providers – especially the cardiovascular care team – to make the routine delivery of tobacco cessation treatment a standard component of cardiovascular care," notes Barua.

Further, the writing committee explains that in treating tobacco dependence, there is a need for clinicians to adopt a chronic disease management strategy that monitors tobacco use over time and makes repeated efforts to encourage and assist smokers to quit using tobacco. "Current evidence strongly supports combining pharmacotherapy with behavioral/psychosocial interventions as the most effective way to help smokers sustain abstinence," they add.

Barua explains that the document "provides tables and figures to illustrate the steps and tools needed to successfully provide comprehensive tobacco cessation treatment." Of note, the document includes treatment algorithms for current smokers, former smokers, patients not ready to quit and addressing smoking cessation in the outpatient setting. Tables include guidance for clinicians' discussions with patients about electronic cigarette use, strategies for addressing barriers to implementing and sustaining smoking cessation treatment, resources for educational information to support tobacco cessation treatment, and recommendations for components of a tobacco cessation program in an inpatient or outpatient setting, and more.

"With more evidence generated from ongoing research, refinement of this decision pathway will be needed," conclude Barua et al. "For now [we hope] that this decision pathway will help clinicians to improve the quality and effectiveness of the tobacco cessation strategies they provide to their patients."

Keywords: Tobacco Use Disorder, Smoking Cessation, Tobacco, Tobacco Use Cessation, Tobacco Smoke Pollution, Inpatients, Outpatients, Tobacco Products, Tobacco Use, Chronic Disease, Cardiovascular Diseases

< Back to Listings