Barriers to recommending nicotine replacement therapy to acute cardiac patients

Introduction: The relationship between tobacco smoking and the increased risk of developing coronary heart disease (CHD) is well established, so to the dramatic reduction in risk associated with smoking cessation. The implementation of smoking cessation strategies at both primary and secondary prevention levels has been recognised as a way to alleviate the crippling population health effects of this disease. Nicotine replacement therapy (NRT) has been shown to double 12 month abstinence rates compared with placebo; however NRT is underutilized in the CHD population. This study explores the attitudes and beliefs of healthcare professionals regarding NRT use in hospitalised CHD patients, and also aims to identify barriers which may impede the use of this drug in the cardiac care environment. Method: Framework analysis provided a structure for the analysis of data generated via semi-structured one on one interviews. Healthcare professionals practicing in the cardiac care environment informed the study. Results: Although participants had strong views regarding the benefits of NRT as a smoking cessation intervention in the cardiac care setting various barriers appear to hinder its utilisation. Financial implications, lack of knowledge, and safety issues all seem to form the justification for rejecting hospital based NRT as a secondary prevention intervention. Conclusions & Recommendations: Nicotine replacement products require further investigation to ascertain their safety and financial viability in the cardiac care environment. At present there seems to be a greater emphasis placed on unsubstantiated risks associated with NRT than the substantiated risks associated with the continuance of smoking in the hospitalised CHD population. Addressing misconceptions about the safety and effectiveness of NRT, and common barriers to its use in this high risk population, may help to encourage recommendation by health professionals to those with CHD, and ultimately aid in reducing the incidence of smoking related mortality due to acute cardiac events.