胸痛观察单元：启动戒烟治疗的错失机会。
Chest pain observation unit: A missed opportunity to initiate smoking cessation therapy.
机构信息
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
出版信息
Am J Emerg Med. 2023 Jun;68:17-21. doi: 10.1016/j.ajem.2023.02.033. Epub 2023 Mar 2.
BACKGROUND
Emergency Department Observation Unit (EDOU) patients with chest pain have a high prevalence of smoking, a key cardiovascular disease risk factor. While in the EDOU, there is an opportunity to initiate smoking cessation therapy (SCT), but this is not standard practice. This study aims to describe the missed opportunity for EDOU-initiated SCT by determining the proportion of smokers who receive SCT in the EDOU and within 1-year of EDOU discharge and to evaluate if SCT rates vary by race or sex.
METHODS
We performed an observational cohort study of patients ≥18 years old being evaluated for chest pain in a tertiary care center EDOU from 3/1/2019-2/28/2020. Demographics, smoking history, and SCT were determined by electronic health record review. Emergency, family medicine, internal medicine, and cardiology records were reviewed to determine if SCT occurred within 1-year of their initial visit. SCT was defined as behavioral interventions or pharmacotherapy. Rates of SCT in the EDOU, 1-year follow-up period, and the EDOU through 1-year of follow-up were calculated. SCT rates from the EDOU through 1-year were compared between white vs. non-white and male vs. female patients using a multivariable logistic regression model including age, sex, and race.
RESULTS
Among 649 EDOU patients, 24.0% (156/649) were smokers. These patients were 51.3% (80/156) female and 46.8% (73/156) white, with a mean age of 54.4 ± 10.5 years. From the EDOU encounter through 1-year of follow-up, only 33.3% (52/156) received SCT. In the EDOU, 16.0% (25/156) received SCT. During the 1-year follow-up period, 22.4% (35/156) had outpatient SCT. After adjusting for potential confounders, SCT rates from the EDOU through 1-year were similar among whites vs. non-whites (aOR 1.19, 95% CI 0.61-2.32) and males vs. females (aOR 0.79, 95% CI 0.40-1.56).
CONCLUSIONS
SCT was rarely initiated in the EDOU among chest pain patients who smoke and most patients who did not receive SCT in the EDOU never received SCT at 1-year of follow-up. Rates of SCT were similarly low among race and sex subgroups. These data suggest an opportunity exists to improve health by initiating SCT in the EDOU.
背景
急诊科观察单元（EDOU）胸痛患者的吸烟率很高，而吸烟是心血管疾病的一个主要危险因素。在 EDOU 中，有机会启动戒烟治疗（SCT），但这并非标准做法。本研究旨在通过确定在 EDOU 中以及在 EDOU 出院后 1 年内接受 SCT 的吸烟者比例，来描述 EDOU 启动的 SCT 错失机会，并评估 SCT 率是否因种族或性别而异。
方法
我们对 2019 年 3 月 1 日至 2020 年 2 月 28 日在一家三级护理中心 EDOU 接受胸痛评估的年龄≥18 岁的患者进行了一项观察性队列研究。通过电子病历回顾确定人口统计学、吸烟史和 SCT。查阅急诊、家庭医学、内科和心脏病学记录，以确定他们在初次就诊后 1 年内是否接受了 SCT。SCT 定义为行为干预或药物治疗。计算 EDOU、1 年随访期和 EDOU 通过 1 年随访期的 SCT 率。使用包括年龄、性别和种族在内的多变量逻辑回归模型，比较 EDOU 通过 1 年的 SCT 率在白人患者与非白人患者以及男性患者与女性患者之间的差异。
结果
在 649 名 EDOU 患者中，24.0%（156/649）为吸烟者。这些患者中 51.3%（80/156）为女性，46.8%（73/156）为白人，平均年龄为 54.4±10.5 岁。从 EDOU 就诊到 1 年随访期间，仅有 33.3%（52/156）接受了 SCT。在 EDOU 中，有 16.0%（25/156）接受了 SCT。在 1 年随访期间，有 22.4%（35/156）接受了门诊 SCT。在调整了潜在混杂因素后，从 EDOU 通过 1 年的 SCT 率在白人患者与非白人患者之间（优势比 1.19，95%可信区间 0.61-2.32）和男性患者与女性患者之间（优势比 0.79，95%可信区间 0.40-1.56）相似。
结论
在胸痛且吸烟的 EDOU 患者中，SCT 很少在 EDOU 中启动，而大多数在 EDOU 中未接受 SCT 的患者在 1 年随访时也从未接受 SCT。种族和性别亚组的 SCT 率同样较低。这些数据表明，通过在 EDOU 中启动 SCT，有机会改善健康状况。
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