NEJM – Jorunal Watch
By Amy Orciari Herman
Clinicians rarely counsel hospitalized cardiac patients about secondhand smoke exposure, according to a research letter in JAMA Internal Medicine.
Some 200 nonsmoking inpatients with coronary heart disease were interviewed about secondhand smoke exposure. About a fifth reported some exposure in the previous month. Of 72 saliva samples analyzed, 40% were positive for cotinine, a biomarker of exposure.
Just 17% of all patients recalled that a hospital clinician had inquired about secondhand smoke exposure, and only 1% were counseled to maintain a smoke-free home or car.
The authors write: “It is likely that [secondhand smoke] exposure is similarly overlooked in outpatient cardiology practice. Hospitals and health care systems are missing an opportunity to identify and intervene in this major modifiable cardiovascular risk factor.” A commentator adds: “This is a case in which the electronic health record could make a big difference … through the development of ‘prompts’ to inquire about … exposure and ‘hard stops’ to encourage counseling during what may be a prime teachable moment.”
JAMA Internal Medicine research letter (Subscription required)
JAMA Internal Medicine commentary (Subscription required)
Background: NEJM Journal Watch General Medicine summary on smoking bans and MI risk (Your NEJM Journal Watch registration required)