Pharmacist contribution in post-hospitalisation cardiac rehabilitation

Abstract

The provision of smoking cessation services should be prioritised in all cardiovascular disease settings, particularly within cardiac rehabilitation (CR). In the local scenario, there are opportunities for a focus on a pharmacist contribution in smoking cessation interventions in CR. The aim of this study was to develop a pharmacist contribution in post-hospitalisation CR and to evaluate outcomes. An educational smoking cessation intervention was developed and implemented during the initial assessment session of the CR programme for active smokers and those who quit smoking post-cardiac event. Patients were counselled on posology of smoking cessation pharmacotherapy suggested by CR nurses and provided with pamphlets developed by the ‘Health Promotion & Disease Prevention Directorate’. Telephone follow-up was undertaken after 3, 6, and 12 months. Descriptive statistics were undertaken. A framework for a telemedicine-based smoking cessation service in CR was developed. Twenty-four patients (13 active smokers, 11 quit post-cardiac event, 19 male, mean age 56 years, 17 admitted with acute coronary syndrome, 16 referred post-percutaneous coronary intervention) were enrolled. Eight of the 13 smokers accepted to receive smoking cessation pharmacotherapy (NRT n=6, varenicline n=2). After 1 year, 3 patients from the active smoker cohort quit smoking, while 6 of the patients who quit smoking post-cardiac event remained abstinent. The proposed framework for a telemedicine-based smoking cessation service in CR considers a hybrid model to interact with the patient. The developed smoking cessation intervention provided at initial assessment and the telephone follow-ups were intended to complement the present service and support patients to stop smoking. However, most patients were still smoking after 1 year, suggesting that a more aggressive approach in CR to improve smoking cessation outcomes is required. This study proposes a framework which could be implemented in CR with the aim of improving patient accessibility and outcomes.