Bupropion, Smoking Cessation, and Health-Related Quality of Life Following an Acute Myocardial Infarction

Abstract

BackgroundThe use of bupropion, a smoking cessation aid, has been associated with improved health-related quality of life (HRQOL) in the general population of smokers; but, its effect on HRQOL in post-myocardial infarction (MI) patients remains unknown. ObjectivesTo examine the effect of bupropion on HRQOL in post-MI patients who are attempting to quit smoking. MethodsTo accomplish this objective, we used data from a randomized, double-blind, placebo-controlled trial in 392 hospitalized post-MI patients. Treatment duration was 9 weeks, and follow-up was 12 months. HRQOL was assessed via the EuroQol-5D (EQ-5D) questionnaire, which includes 5 dimensions (mobility, self-care, daily activities, pain/discomfort, and anxiety/depression). Analyses were restricted to patients (n=225) who completed the EQ-5D at baseline, 6 months, and 12 months. ResultsPatients randomized to bupropion (n=109) and those randomized to placebo (n=116) experienced similar improvements in HRQOL during follow-up (difference in change in EQ-5D index from baseline to 6 months = 0.02, 95% confidence interval [CI] = -0.04, 0.08; from baseline to 12 months = 0.02, 95% CI = -0.04, 0.08). No between-group differences were observed in any of the 5 dimensions. Similar improvements in HRQOL were observed between patients who remained abstinent and those who relapsed. Lower baseline HRQOL, defined as having a HRQOL that was less than the median value, was associated with decreased smoking abstinence at 12 months follow-up (odds ratio OR =0.39, 95% CI = 0.22, 0.68). ConclusionsBupropion does not improve HRQOL among patients attempting to quit smoking post-MI.

Cancer‐related disease factors and smoking cessation treatment: Analysis of an ongoing clinical trial

“…The importance of adherence is underscored by previous studies which have linked higher treatment adherence to a greater likelihood of smoking cessation, including among the current sample of cancer survivors . That HRQOL was associated with medication adherence is not surprising—HRQOL is often associated with smoking cessation treatment adherence, including among chronic disease populations . In this sample in particular, those participants reporting lower HRQOL may have been experiencing more cancer‐related side effects and therefore were less able to tolerate the side effects associated with varenicline, especially nausea …”

“…19 That HRQOL was associated with medication adherence is not surprising -HRQOL is often associated with smoking cessation treatment adherence, including among chronic disease populations. 26 In this sample in particular, those participants reporting lower HRQOL may have been experiencing more cancer-related side effects and therefore were less able to tolerate the side effects associated with varenicline, especially nausea. 22 Bold indicates significance at P < .05.…”

Smoking Cessation and Quality of Life: Insights From Analysis of Longitudinal Australian Data, an Application for Economic Evaluations

“…Some studies conclude that it may improve HRQoL, 5,6 whereas others show insignificant or negative changes. 4,7,8 These inconsistent findings around the effect of smoking transition on HRQoL may be related to the process of smoking cessation, which is complicated and dependent on multiple factors (such as the number of quit attempts, the number of cigarettes, age, education, and any major health event leading to quitting). 9 In addition, it may take several years of abstinence in smokers for their HRQoL to be the same as nonsmokers.…”