Nicotine and Tobacco Product Use in Cardiac Patients

Cigarette smoking has a proven and profound effect on the incidence of cardiovascular disease. Cardiovascular disease claims more lives of smokers every year than lung cancer (U.S. Department of Health and Human Services, 2014) and 13.7% of all cardiovascular disease mortality in 2014 was attributable to smoking (Go et al., 2014). Acute cardiac hospitalization often promotes change for patients; smoking cessation rates following such events can be as high as 30-40% (Colivicchi et al., 2011; Hajek et al., 2002). However a majority of smoking cardiac patients are still smoking 12 months after their event. This continued smoking elevates risk for future cardiac issues. Among patients with a prior myocardial infarction, current smokers are at a greater risk for a subsequent infarction and death, and smokers who have undergone coronary bypass surgery have an elevated subsequent mortality rate (Critchley & Capewell, 2003). These risks are communicated to the patient and hospitals are highly compliant with implementing their in-hospital smoking cessation measures (Tam et al., 2013). After hospitalization, patients who are unable or unwilling to quit have still likely been sensitized to the risks associated with continued smoking and may pursue alternative avenues of nicotine delivery. Other products that have been promoted as less harmful than smoking, such as e-cigarettes or other non-combustible sources of tobacco or nicotine, may appear to be a safer alternative (Steinberg et al., 2014). E-cigarettes, for example, have been aggressively advertised as a reduced harm product. As a result clinicians (primarily in oncology) have been reporting increased number of patients asking about the use of non-combustible tobacco products (Cummings et al., 2014) and use of e-cigarettes has doubled in a single year among the general population (Grana et al., 2014) with 14% of surveyed adults reporting that they are using or have used e-cigarettes (Agaku et al., 2014). Like oncology patients, cardiac patients, sensitized to the continued risks of smoking, but who are unwilling or unable to quit smoking, may seek out other, potentially less harmful, forms of tobacco. Given the known risks of continued smoking in cardiac patients and the propensity of other clinical populations to adapt alternative forms of tobacco, it is important to track usage of these alternative products in cardiac populations. Thus the purpose of the current study is to characterize the recent tobacco use of hospitalized cardiac patients, track how that usage changes following recovery from their acute event, and identify characteristics which may be predictive of changes in use. Patients hospitalized for acute coronary events (specifically myocardial infarction and coronary artery bypass surgery) who report using tobacco or nicotine products prior to their hospitalization will be approached. Consenting patients will be administered a questionnaire containing questions about past and current tobacco use as well as prior or current use of any alternative tobacco products. The questionnaire will also cover basic demographic questions and a few questions about recent mood. Patients will then be contacted 3 months following their event for a follow-up where the survey questions will be repeated. Changes in smoking status (reduction, cessation or relapse) as well as uptake of alternative tobacco products (e.g. initiation of e-cigarettes or smokeless tobacco) will be tracked. Participants will be recruited for the first nine months of the study with follow-up surveys being conducted in months four through twelve. To increase recruitment and retention all subjects who complete the follow up will be entered in a drawing for one of fifteen $20 gift cards. Key words: Cardic patients, Tobacco Use, Nicotine, Electronic cigarettes