Tobacco Cessation in VAD Patients: The Power of Incentive

Abstract

It is well-documented that tobacco smoking has significant cardiovascular ramifications. However, the effects of tobacco smoking upon Ventricular Assist Device (VAD) implant outcomes are understudied. We aimed to ascertain the effort that institutions devote to smoking cessation programs for VAD patients and the success of these programs. Using Survey Monkey®, a 13-question survey was created and distributed to 26 VAD institutions. Examples of multiple-choice questions included: 1) the volume of VAD patients at the respondent's center, 2) the patient population with active or past use of tobacco, 3) the presence and breadth of smoking cessation programs, and 4) the respondents' views on program success. Respondents (n=15, 58%) stated that more male patients (n=12,75%) were smokers at the time of implantation. The most prevalent ages of tobacco smoking among patients were nearly evenly distributed between the ages of 35-70, but one institution reported the most common age as below 35 years. While pre-implant smoking cessation was not required at most programs (n=13, 87%), nearly all (n=14, 93%) offered cessation therapy after implant, with half of the respondents viewing the programs as effective. There was no apparent correlation between feelings of effectiveness and the category of tobacco smoking cessation therapy (Figure 1). Several respondents indicated that tobacco smoking cessation programs are not effective in Destination Therapy patients, while Bridge-to-Candidacy offers an incentive for compliance. Although tobacco smoking is not a contraindication for device implantation, our data suggests programs are dedicated to utilizing smoking cessation strategies for patients. However, no definitive strategy was identified in successful tobacco smoking cessation programs in our study, pointing to the need for research. Additionally, studies of standards, protocols, and team involvement are areas that could provide data to improve the outcomes of tobacco smoking cessation among VAD patients.