ACC releases expert consensus decision pathway on tobacco cessation treatment

The American College of Cardiology's 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment 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 pathway, which includes tables and flowcharts to guide implementation in clinical settings, was published Dec. 5 by the Journal of the American College of Cardiology.

Cardiovascular care teams should ensure that patients are asked about cigarette smoking and other tobacco product use at all clinical encounters, the pathway states. Patients who use any tobacco product should receive clear advice to stop. Each person should be offered a brief intervention that includes prescriptions for smoking cessation drugs and evidence-based behavioral support.

Patients who are former smokers, especially those who have stopped smoking in the past year, should be monitored closely for possible relapse. Nonsmokers (i.e., both those who used to smoke and those who never did) should routinely be asked about exposure to secondhand smoke and advised to avoid it.

The pathway expands upon the 2008 U.S. Public Health Service (USPHS) Clinical Practice Guideline for Treatment of Tobacco Use and Dependence but reflects newer evidence and changing patterns of practice, the authors wrote.

“Tobacco use, especially cigarette smoking, is a major risk factor for CVD [cardiovascular disease]–associated morbidity and mortality,” the authors wrote. “The reversible relationship between cigarette smoking and CVD provides a strong rationale for health care providers—especially the [cardiovascular] CV care team—to make the routine delivery of tobacco cessation treatment a standard component of CV care.”