The American College of Cardiology has issued a decision pathway to help clinicians treat patients with tobacco dependence.
The document centers on a chart that takes clinicians from asking about tobacco use (recommended during every clinical encounter) through following up after treatment. Among the other highlights: a review of FDA-approved tobacco cessation medications, recommendations for assessing relapse risk in former smokers, and guidance on discussing electronic cigarette risks.
This ECDP provides a structured approach to evaluating and treating tobacco dependence and offers practical guidance for overcoming challenges commonly encountered in the clinical setting. The Decision Pathway recommends that clinicians and practices establish a team-based system of care that recognizes cigarette smoking as a chronic relapsing substance use disorder caused by addiction to nicotine. The care team should ensure that patients are asked about cigarette smoking and other tobacco product use at all clinical encounters.
Patients who use any tobacco product should receive clear advice to stop tobacco use and be offered a brief intervention that includes prescriptions for proven pharmacological smoking cessation aids and proactive connection to evidence-based behavioral support based in the healthcare system and/or the community.
Former smokers, especially recent quitters (i.e., those who have stopped smoking in the past year), should be monitored closely for possible relapse back to smoking. Nonsmokers (i.e., both former smokers and never smokers) should routinely be asked about exposure to secondhand smoke and advised to avoid it.
This ECDP also addresses steps to follow when implementing evidence-based therapies and treating special patient groups while also acknowledging situations for which few data exist. It provides tables and figures to illustrate the steps and tools needed to successfully provide comprehensive tobacco cessation treatment.
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