Efficacy and Safety of Smoking Cessation Interventions in Patients With Cardiovascular Disease

Abstract

1T he efficacy and safety of pharmacological and behavioral smoking cessation interventions have been examined in multiple randomized controlled trials (RCTs), with subsequent meta-analyses showing that such interventions are efficacious at increasing quit rates.1,2 However, participants in these trials were generally healthy, and the generalizability of these data to patients with cardiovascular disease (CVD) is unclear. This unclear generalizability is underscored by 3 trials that found that the smoking cessation drug bupropion did not increase the prevalence of abstinence when used in patients with acute manifestations of CVD. [3][4][5] This may be because of fundamental differences between such patients, who tend to have higher quit rates without therapy because of an increased motivation to quit and the teachable moment that occurs after an adverse event, 6 and the otherwise healthy smokers enrolled in previous RCTs. 6,7 Similarly, the generalizability of RCTs conducted in the general population to patients with stable CVD is also unknown. A thorough assessment of the effect of smoking cessation interventions in CVD patients is needed to develop tailored recommendations to increase abstinence in the CVD population. Consequently, we conducted a systematic review and network meta-analysis of RCTs to evaluate the relative efficacy and safety of pharmacological and behavioral smoking cessation interventions in CVD patients.Background-Although the efficacy and safety of smoking cessation interventions are well established, their efficacy and safety in patients with cardiovascular disease (CVD) remain unclear. The objective of this study was to evaluate the efficacy and safety of pharmacological and behavioral smoking cessation interventions in CVD patients via a metaanalysis of randomized controlled trials. Methods and Results-EMBASE, PsycINFO, MEDLINE, PubMed, and the Cochrane Tobacco Addiction SpecializedRegister were searched for randomized controlled trials evaluating the efficacy of smoking cessation pharmacotherapies and behavioral therapies in CVD patients. Outcomes of interest were smoking abstinence at 6 and 12 months, defined using the most rigorous criteria reported. Data were pooled across studies for direct comparisons using random-effects models. Network meta-analysis using a graph-theoretical approach was used to generate the indirect comparisons. Seven pharmacotherapy randomized controlled trials (n=2809) and 17 behavioral intervention randomized controlled trials (n=4666) met our inclusion criteria. Our network meta-analysis revealed that varenicline (relative risk [ MethodsOur systematic review and network meta-analysis was performed after a prespecified protocol and is reported using the guidelines described in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for reporting of systematic reviews incorporating network meta-analyses. 8 Data SourcesWe systematically searched Ovid EMBASE, Ovid PsycINFO, Ovid MEDLINE, PubMed, and the Cochrane Tobacco Addiction G...

Smoking abstinence 1 year after acute coronary syndrome: follow-up from a randomized controlled trial of varenicline in patients admitted to hospital

“…[11][12][13] Along with bupropion, varenicline has been shown to increase abstinence in patients with stable cardiovascular disease; however, its efficacy in patients with acute coronary syndrome was previously unknown. 6 We have recently shown that use of varenicline increases smoking abstinence 24 weeks after acute coronary syndrome. 14 Here we report evidence concerning the efficacy and safety of varenicline for smoking cessation 52 weeks after acute coronary syndrome.…”

Short‐Term Safety of Nicotine Replacement in Smokers Hospitalized With Coronary Heart Disease

“…Because these symptoms are largely relieved with NRT, increased use of NRT should improve quality of care and patient experience for many smokers,32, 33, 34 and should also help avoid nicotine withdrawal‐associated delirium 35, 36. Second, because inpatient NRT use has been associated with greater outpatient NRT use13 and NRT is a well‐accepted and generally effective treatment for smoking cessation,37, 38 greater use of NRT in the inpatient setting should positively influence long‐term smoking cessation rates 14. Third, because the Joint Commission now considers prescription of pharmacotherapy for smoking cessation (of which the vast majority is NRT) a standard of care for both inpatient use and at hospital discharge,39 and patient motivation to quit smoking is high after a hospitalization, we believe that hospitals can pursue quality initiatives40 to ensure that all hospitalized smokers are offered and prescribed smoking cessation medications to improve smoking cessation outcomes and to meet Joint Commission performance measures.…”

Smoking Influence on the Outcomes and Complications of Coronary Bypass Surgery

“…Телефонное консультирование способствовало отказу от курения в течение 6 и более месяцев в 1,47 раз (95% ДИ 1,15-1,88), а индивидуальное консульти-рование -в 1,64 раза (95% ДИ 1,17-2,28), при этом короткий совет медицинского работника отказаться от курения в большинстве случаев к значимому результату не приводил: ОШ =1,05, (95% ДИ 0,78-1,43). Авторы связывают это с формальным подходом медицинских работников и отсутствием знаний по проведению когнитивно-поведенческой терапии [32]. Авторы делают вывод о необходимости назначе-ния варениклина и бупропиона для лечения никоти-новой зависимости у больных ССЗ.…”