Use of Prescription Smoking Cessation Medications After MI Among Older Patients in Community Practice

Despite the clear health benefits of smoking cessation observed among individuals who have experienced myocardial infarction (MI), the rates smoking cessation medication (SCM) use post MI in this population have historically been low and continue to decline over time, according to a research letter published in JAMA: Cardiology.

Analyzing data from the Acute Coronary Treatment and Intervention Outcomes Network Registry, the largest MI registry in the U.S., authors Neha J. Pagidipati, MD, MPH, et al., found that there were 183,783 hospital admissions for MI between April 2007 and Dec. 2013. Approximately 15 percent of those patients were current or recent smokers. Prescription SCMs included in the study were bupropion and varenicline. Nicotine replacement therapies were available over the counter.

Overall, only 52.8 percent of patients with MI quit smoking within the first year following the event. Among the 9,193 smoking patients with MI in the authors’ cohort, 97 percent received smoking cessation counseling during their hospitalization, yet only 7 percent employed early-prescription SCM use, defined as the filling of a prescription within 90 days post-discharge or using remaining medication from a pre-admission fill. The median duration of use was 6.2 weeks for bupropion and 4.3 weeks for varenicline; only 36.7 percent and 19.7 percent, respectively, went on to fill prescriptions for the recommended 12-week course. Within one year following discharge, SCM use increased to just over 9 percent.

Patients taking a prescription for SCM prior to the MI episode more frequently used SCMs within the first year post MI. Younger female patients and patients living in counties with greater than the median high school graduate rate were more likely to participate in early SCM use when compared with patients who did not use prescription SCM early post MI. Notably, with each five-year decrease in age, likelihood of early SCM use grew by 52 percent.

“The results of our study suggest the need for words (smoking cessation counseling rates are high) to be followed by action (SCM use rates can be higher). Patients of older age, male sex, and lower education levels may represent key target populations for more intensive smoking cessation counseling and assistance,” write Pagidipati, et al. “Our study also showed shorter duration of use compared with typically recommended courses, which suggests opportunities for further education on adherence to reduce relapses in smoking behavior.”

Clinical Topics: Prevention, Smoking

Keywords: Smoking Cessation, Bupropion, Smoking, Nicotine, Health Services Needs and Demand, Tobacco Use Disorder, Counseling, Patient Discharge, Myocardial Infarction

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