The following is a summary of “Chest pain observation unit: A missed opportunity to initiate smoking cessation therapy,” published in the June 2023 issue of Emergency Medicine by Ashburn et al.

Patients admitted to the Emergency Department Observation Unit (EDOU) with chest symptoms have a high prevalence of smoking, a significant risk factor for cardiovascular disease. It is possible to initiate smoking cessation therapy (SCT) in the EDOU, but this is not standard practice. This study seeks to characterize the missed opportunity for EDOU-initiated SCT by determining the proportion of smokers who receive SCT in the EDOU and within one year of EDOU discharge and whether SCT rates vary by race or gender. From 3/1/2019 to 2/28/2020, the researchers conducted an observational cohort study of patients ≥18 years old being evaluated for chest symptoms at a tertiary care center EDOU. 

The demographics, smoking history, and SCT were determined by examining electronic health records. Emergency, family medicine, internal medicine, and cardiology records were reviewed to ascertain whether SCT occurred within one year of the patient’s initial visit. Behavioral interventions or pharmacotherapy were defined as SCT. SCT rates were calculated for the EDOU, the 1-year follow-up period, and the EDOU through the 1-year follow-up period. White patients were compared to non-white patients, and male patients were compared to female patients using a multivariable logistic regression model that included age, gender, and ethnicity. Among 649 EDOU patients, 24.0% (156/649) were smokers. These patients were 51.3% female (80/156), 46.8% white (73/156), and had a mean age of 54.4±10.5 years. From the EDOU encounter to the one-year follow-up, only 33.3% (52/156) of individuals received SCT. 

About 16.0% (25/156) of the EDOU received SCT. During the one year of follow-up, 22.4% (35/156) underwent SCT as an outpatient. SCT rates from the EDOU through 1 year were comparable between whites and non-whites (aOR 1.19, 95% CI 0.61–2.32) and between males and females (aOR 0.79, 95% CI 0.40–1.52). Infrequently SCT was initiated in the EDOU among patients with chest symptoms who smoked, and the majority of patients who did not receive SCT in the EDOU did not receive SCT at 1-year follow-up. Rates of SCT were low across all racial and sexual subgroups. These data suggest that implementing SCT in the EDOU presents an opportunity to enhance health.

 Source: sciencedirect.com/science/article/abs/pii/S073567572300102X