1. Smoking Cessation

2. Smoking Kills and Causes Heart Attacks
One area that is incredibly important, but incredibly difficult to address in our population is smoking. We know from several large studies now that smoking seems to have an even greater effect on mortality and CVD in our population than it does in the uninfected population.
Helleberg et al, Clin Inf Dis, 2012
Rasmussen et al, Clin Inf Dis, 2015

3. Quitting is really hard

4. In the general population…
1 in 10 will succeed with pill AND patch
1 in 20 will succeed with pill OR patch
1 in 5 will succeed with pill AND patch AND support
50% of smokers will try to stop smoking
OF THESE, 1 in 50 will succeed without help

5. For PLWHIV… Short term success is possible
12 total interventions
Short term (<6 months)
Long term (>6 months)
Pooled long term abstinence was 8%
Pool et al, Cochrane Database Syst Rev, 2016

6. … but long-term success is hard to achieve
Largest of these Vidrine et al was a cell-phone intervention
Pool et al, Cochrane Database Syst Rev, 2016

7. A practical approach for clinicians: The 5 A’s
Ask
Advise
Assess
Assist
Arrange
smokefree.gov -- free resources from the National Cancer Institute
And so we are left trying our best with evidence-based approaches from the general population. The National Cancer Institute and others have suggested the following practical approach for clinician’s– the 5 A’s.
Ask: Ask about tobacco use at every visit. This can be done systematically with the use of patient reported questionnaires.
Advise: Advise all tobacco users to quit. Simple language. Besides taking your HIV medicines, quitting smoking is the most important thing you can do to protect your health.
Assess: Assess readiness to quit
Assist: Assist tobacco users with a quit plan. Discuss nicotine replacement and other adjunctive medications.
Arrange: Arrange follow-up, ideally with a smoking cessation counselor

10. Concluding Thoughts

11. Team-based cardiovascular health promotion
Primary HIV care
Dietician
Nursing Staff
Social Work
Smoking Cessation
HIV Cardiometabolic Risk Clinic
I think it is definitely possible. How do we get there? I think it will be through approaches similar to what we’ve taken at University Hospitals of Cleveland, where we have a multi-disciplinary team working together to address all aspects of CVD prevention. Because of the unique spirit of shared experience that permeates HIV clinics, I think this can be a highly motivating model for patients.

12. A nurse-led intervention to EXtend the HIV TReatment cAscade for CardioVascular Disease prevention:

13. World Heart Day: September 29, 2018
“It’s about saying to ourselves, the people we care about and individuals all around the world, “what can I do right now to look after MY HEART… and YOUR HEART?”

14. Heart Health & HIV:
It Starts with YOU
Thank you!