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Commentary
January 17, 2023

Practice Current
Variability in Smoking Cessation Intervention Practice Patterns After Ischemic Stroke and Transient Ischemic Attack

Abstract

People who continue to smoke after ischemic stroke and transient ischemic attack (TIA) are at increased risk for subsequent stroke and cardiovascular events. Although effective smoking cessation strategies exist, smoking rates after stroke remain high. Through case-based discussions with 3 international vascular neurology panelists, this article seeks to explore practice patterns and barriers to smoking cessation for patients with stroke/TIA. We sought to answer these questions: What are the barriers to using smoking cessation interventions for patients with stroke/TIA? Which interventions are most used for hospitalized patients with stroke/TIA? Which interventions are most used for patients who continue smoking during follow-up? Our synthesis of panelists' commentaries is complemented by the preliminary results of an online survey posed to global readership. Together, the interviews and survey results identify practice variability and barriers to smoking cessation after stroke/TIA, suggesting that there is substantial need for research and standardization.

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Biographies

Bo Norrving, MD is a Professor of Neurology and Chair of the Stroke Policy and Quality Research Group at Lund University, Sweden. Professor Norrving served as the president of the World Stroke Organization (WSO) between 2008 and 2012. He continues to serve the WSO as a member of its Global Policy Committee. Upon graduating from Lund University in 1975, Dr. Norrving remained there as a member of the Neurology Department. He is a distinguished clinical researcher with a focus on stroke epidemiology, stroke syndromes, small vessel disease, ultrasound, quality registers, clinical genetics, and clinical trials. He has contributed to over 300 peer-reviewed articles and has authored or co-authored several books, including The Oxford Textbook on Stroke and Cerebrovascular Disease. He was a member of the Swedish Aspirin Low-Dose Trial (SALT) that was published in The Lancet in 1991. In 1994, he was the founder of Riksstroke, the world's first national stroke registry. He remains actively involved in research using Riksstroke data in his role as Chair of the Stroke Policy and Quality Research Group. He previously served as the European Editor of Stroke from 2005 to 2010 and remained a Senior Consulting Editor until 2015. Since 2016, he has served as the Editor-in-Chief of the European Stroke Journal. He received the WSO leadership in Stroke Medicine Award (2014), Karolinska Stroke Award (2014), and American Heart Association/American Stroke Association Sherman Award (2016), all of which recognize his lifetime contributions to stroke science.
Jeyaraj Pandian, MBBS is a Consultant Neurologist and the Principal (Dean) of the Christian Medical College, Ludhiana. He currently serves as the President of the Indian Stroke Association and Vice-President of the WSO. After receiving his MBBS from Tirunelveli Medical College, Tamil Nadu, Dr. Pandian received a MD in Internal Medicine from Christian Medical College. He then completed a neurology residency at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, followed by a stroke fellowship at the Royal Brisbane and Women's Hospital in Brisbane, Australia. Dr. Pandian has been extensively involved in stroke prevention research and the establishment of surveillance and care infrastructure. His group has trained community health workers called Accredited Social Health Activists in rural areas to identify patients with stroke and help them to receive acute stroke care. He also played a role in the Indian Stroke Clinical Trial Clinical Network, which facilitates small and large clinical trials and research studies to advance acute stroke treatment, stroke prevention, and recovery and rehabilitation after stroke at 30 centers around India. He is the Editor-in-Chief of CHRISMED Journal of Health and Research and Journal of Stroke Medicine. He also serves on the Editorial Board of the International Journal of Stroke, Journal of Stroke, and European Stroke Journal. He has been elected as a Fellow of the Royal Australasian College of Physicians, Royal College of Physicians, European Stroke Organization, World Stroke Organization, and National Academy of Medical Sciences.
Anjail Sharrief, MD, MPH is an Associate Professor of Neurology and the Director of Stroke Prevention for the Institute of Stroke and Cerebrovascular Disease at the McGovern Medical School at UT Health Houston. She is the founder and director of the Stroke Clinic and the Stroke Transitions Education and Prevention (STEP) program at UT Health Houston. Dr. Sharrief completed her medical education at Columbia University's College of Physicians and Surgeons. She then went on to complete neurology residency at Johns Hopkins Hospital. She also holds a Masters of Public Health from the Johns Hopkins Bloomberg School of Public Health. Dr. Sharrief's research focuses on disparities and health outcomes among stroke survivors. She has received grants to work on novel healthcare delivery models for secondary stroke prevention. In 2021, she received a $3.1 million grant from the National Institute on Minority Health and Health Disparities at the NIH to launch a trial testing whether multidisciplinary telehealth intervention can improve racial outcomes among adult stroke survivors.
Letters to the Editor

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 13Number 1February 2023
Editor: Aravind Ganesh, MD, DPhil, FRCPC

Publication History

Received: April 18, 2022
Accepted: October 12, 2022
Published online: January 17, 2023
Published in print: February 2023

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Disclosure

N.S. Parikh was supported by NIH/NIA (K23 AG073524) and the Florence Gould Foundation, has received personal compensation for medicolegal consulting on stroke, and has received research support from the New York State Empire Clinical Research Investigator Program and Leon Levy Foundation; D. Restifo reports no disclosures relevant to this manuscript; A. Ganesh reports funding from the Wellcome Trust, Canadian Institutes of Health Research, Canadian Cardiovascular Society, Campus Alberta Neuroscience, and Alberta Innovates, consultation fees from Atheneum, MD Analytics, MyMedicalPanel, Creative Research Designs, and DeepBench, and stock options from SnapDx, TheRounds.com, and Advanced Health Analytics (AHA Health Ltd); H. Kamel serves as a PI for the NIH-funded ARCADIA trial (NINDS U01NS095869) which receives in-kind study drug from the BMS-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics, serves as a Deputy Editor for JAMA Neurology, serves as a steering committee member of Medtronic's Stroke AF trial, serves on a trial executive committee for Janssen, and serves on an endpoint adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Study Funding

The authors report no targeted funding.

Authors

Affiliations & Disclosures

Neal S. Parikh, MD, MS
Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
Stroke, Editorial Board member, 2019
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Medicolegal consulting/expert witness work.
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH/NIA K23AG073524, PI, 2021-2026; New York State Empire <br>Clinical Research Investigator Program, <br>Fellow, 2020-2021.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Leon Levy Foundation Fellowship in Neuroscience; Florence <br>Gould Foundation Endowment for Discovery in Stroke.
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Daniel Restifo, MS
Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Aravind Ganesh, MD, DPhil, FRCPC
Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) University of Calgary Post-Graduate Medical Education <br>(PGME): travel funding for conferences<br>(2) American Academy of Neurology: Futures in Neurological <br>Research award, resident scholarships, International <br>Scholar award<br>(3) Alexion: honoraria for educational presentation
Editorial Boards:
1.
(1) Neurology Editorial Board, Disputes and Debates, 2018-<br>Present<br>(2) Neurology: Clinical Practice Editorial Board, Practice <br>Current, 2019-Present<br>(3) Stroke, Editorial Board Member, 2019-present<br>(4) Frontiers in Neurology, Editorial Board Member, 2021
Patents:
1.
Patent application (US 17/317,771) for a system <br>for patient monitoring and delivery of remote ischemic <br>conditioning or other cuff-based therapies.
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) MD Analytics: honoraria for research consultation<br>(2) My Medical Panel: honoraria for research consultation<br>(3) DeepBench: honoraria for research consultation<br>(4) Research On Mind: honoraria for research consultation<br>(5) Figure 1: honoraria for educational consultation<br>(6) CTC Communications Corporation: honoraria for <br>educational consultation<br>(7) Atheneum: honoraria for research consultation<br>(8) Biogen: honoraria for educational consultation
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Government of Canada INOVAIT program, PI, 2021-2022
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Alberta Innovates<br>(2) Canadian Institutes of Health Research<br>(3) Canadian Cardiovascular Society<br>(4) Campus Alberta Neuroscience<br>(5) New Frontiers in Research Fund
Stock/stock Options/board of Directors Compensation:
1.
(1) SnapDx Inc.<br>(2) TheRounds.com<br>(3) Advanced Health Analytics (AHA Health Ltd)
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Hooman Kamel, MD, MS
Clinical and Translational Neuroscience Unit (NSP, DR, HK), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York City; and Department of Clinical Neurosciences (AG), University of Calgary, Alberta, Canada.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
(1) Journal Watch Neurology, Associate Editor, 2011-2016.<br>(2) PLOS One, Academic Editor, 2013-2016<br>(3) Scientific Reports, Editorial Board Member, 2014-<br>2016.<br>(4) JAMA Neurology, Deputy Editor, 2017-current.
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Has served on a one-time advisory board for Roivant <br>Sciences related to Factor XI inhibition (2018).
Speakers' Bureaus:
1.
(1) Speakers bureau for Genentech, Inc., 2012-2016
Other Activities:
1.
(1) Steering Committee of Medtronic's Stroke AF trial <br>(uncompensated).<br>(2) Stroke endpoint adjudication committee for diabetes-<br>related drug for Boehringer-Ingelheim.<br>(3) Executive Committee for a Janssen trial.
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Dr. Kamel serves as co-PI for the NIH-funded ARCADIA <br>trial (NINDS U01NS095869) which receives in-kind study <br>drug from the BMS-Pfizer Alliance for Eliquis&#x00AE; and <br>ancillary study support from Roche Diagnostics.
Research Support, Government Entities:
1.
(1) NIH/NINDS, K23NS082367, 2013-current.<br>(2) NIH/NINDS, R01NS097443, 2016-2021.<br>(3) NIH/NINDS, U01NS095869, 2016-current.<br>(4) NIH/NINDS, R01HL144541, 2019-current.
Research Support, Academic Entities:
1.
Dr. Kamel serves as a PI for the NIH-funded ARCADIA trial <br>(NINDS U01NS095869), which receives in-kind study drug from <br>the BMS-Pfizer Alliance for Eliquis&#x00AE; and ancillary study <br>support from Roche Diagnostics; as Deputy Editor for JAMA <br>Neurology; on clinical trial steering/executive committees <br>for Medtronic, Janssen, and Javelin Medical; and on endpoint <br>adjudication committees for Novo Nordisk and Boehringer <br>Ingelheim.
Research Support, Foundations and Societies:
1.
(1) Michael Goldberg Stroke Research Fund, 2014
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Parikh [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

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