Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Tobacco use is a modifiable risk factor for major adverse cardiovascular events (MACE) in liver transplant recipients (LTRs). However, data are lacking about practitioner adherence to tobacco guidelines for LTRs. This study assessed practitioner adherence to the guidelines as a predictor of MACE after LT.
*Methods: An inception cohort of 602 LTRs from an urban, tertiary care hospital between 2010 and 2016, ages 18-79 years, who survived to hospital discharge, were classified as current, former, or never smokers, using electronic health record (EHR) data. EHR review assessed tobacco cessation interventions (counseling/pharmacologic treatment/referral) offered annually post-transplant. The primary outcome was MACE, defined as death from a cardiovascular cause or hospitalization for myocardial infarction, revascularization, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism, or stroke.
*Results: Among 602 LTRs (mean age 56.7, 63.8% male, 60.8% non-Hispanic white), 326 (54%) were never smokers, 36.6% former smokers, and 9.4% current smokers. Tobacco use was annually assessed in the majority (up to 59%) of LTRs. Among current smokers, documented smoking cessation counseling decreased over time (50% in year 1 to 25% in year 6 post-LT), and <25% of LTRs were offered pharmacologic treatment or referral to counseling. There was no significant decrease in the proportion of LTRs who were current smokers over time. There was also no difference in MACE between smokers who received any cessation intervention (16.8 MACE per 1000-person years) compared with those who did not (22.8 MACE per 1000 person-years, p=1.0).
*Conclusions: Smoking cessation interventions were not associated with a decrease in MACE among LTRs. However, receipt of these interventions was inconsistently documented. Multiple factors may contribute to poor adherence to smoking cessation guidelines, including clinical time constraints, and lack of awareness or insufficient expertise in providing effective counseling. Identification of barriers and facilitators for effective tobacco cessation interventions and the effect of quality improvement efforts aimed at improving adherence are likely needed to potentially reduce MACE among high-risk LTRs.
To cite this abstract in AMA style:Kosirog M, Campbell PT, Montag S, Connolly S, Daud A, Das A, Pine S, Finn D, Levitsky J, Holl JL, Lloyd-Jones D, VanWagner LB. Poor Practitioner Adherence to Clinical Tobacco Use Guidelines in Liver Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/poor-practitioner-adherence-to-clinical-tobacco-use-guidelines-in-liver-transplant-recipients/. Accessed July 17, 2019.
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