Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome
What is the long-term efficacy and safety of adding bupropion slow-release (SR) to in-hospital and post-discharge counseling for smoking cessation?
In a double-blind, randomized, controlled trial, the investigators compared the safety and efficacy of 8 weeks of treatment with bupropion SR or placebo for smokers hospitalized with acute coronary syndrome (ACS) as an adjunct to nurse-led hospital- and telephone-based support. Primary efficacy outcome was smoking abstinence at 1 year. Primary safety outcome was clinical events at 1 year.
A total of 151 patients were enrolled; all but two completed follow-up. Abstinence rates at 3 months were 45% versus 44% in the bupropion SR and placebo groups, respectively (p = 0.99); 37% versus 42% (p = 0.61) at 6 months; and 31% versus 33% (p = 0.86) at 1 year. On multivariate analysis, an invasive procedure performed during index hospitalization was an independent predictor for smoking abstinence at 1 year (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.22-14.19). Presence of adverse effects attributed to treatment was a negative predictor for smoking cessation (OR, 0.23; 95% CI, 0.07-0.78). Treatment with bupropion SR was not associated with an increase in clinical events or change in blood pressure or body mass index, but dizziness was more common compared with placebo (14% vs. 1.4%; p = 0.005).
The authors concluded that in hospitalized patients with ACS who received continuous, intensive nurse counseling about smoking cessation, bupropion did not increase the rates of smoking abstinence.
The study results suggest that although bupropion SR is safe in patients hospitalized with ACS, it had no added value over placebo in this population when combined with intensive smoking cessation counseling. Based on this, adding bupropion to intensive counseling may be considered only in selected patients such as patients with post–myocardial infarction depression. Overall, the study emphasizes the unique opportunity to approach heavy smokers during hospitalization with ACS, in a forced nonsmoking environment, utilizing the effect of a life-threatening condition in order to achieve long-term high abstinence rates.
Clinical Topics: Acute Coronary Syndromes
Keywords: Depression, Myocardial Infarction, Acute Coronary Syndrome, Follow-Up Studies, Counseling, Tobacco Use Disorder, Hospitalization, Smoking Cessation, Bupropion
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