Abstract 15968: Use of Prescription Smoking Cessation Medications After Myocardial Infarction in Community Practice
Introduction: Hospitalization for an acute myocardial infarction (MI) is an ideal opportunity to initiate smoking cessation interventions. Prescription medications such as bupropion and varenicline have benefits for smoking cessation beyond counseling, however their use in MI patients is unknown. We sought to evaluate community-based use patterns of smoking cessation medication (SCM) in a national registry of MI patients.
Methods: We examined patients over age 65 hospitalized for STEMI or NSTEMI in 377 US hospitals participating in ACTION Registry-GWTG between 2007 and 2009. Bupropion or varenicline use was ascertained from linked Medicare part D prescription fill data among patients denoted as recent smokers on the ACTION data collection form. Multivariable logistic regression was used to determine characteristics associated with SCM use within 90 day post-discharge.
Results: Among 2,373 MI patients who were recent smokers, 96% were documented to receive smoking cessation counseling before discharge. Yet, only 233 (9.8%) filled a prescription for a SCM (27% bupropion, 73% varenicline) by 90 days post-discharge, and only 308 (13.0%) filled a prescription for a SCM by 1 year. The median duration of use was 4.7 weeks for bupropion (which is typically used for 6-12 months) and 4.3 weeks for varenicline (which is typically used for 3 months). Among patients who did not fill an SCM post-discharge by 90 days post-MI, only 1.5% had previously tried SCM in the 3 months prior to their MI hospitalization. Among 17 sociodemographic, medical history, and in-hospital characteristics included in the multivariable model, only white race (OR 2.32 [1.39-3.86] vs non-white) and female sex (OR 1.38 [1.05-1.82] vs men) were associated with higher likelihood of SCM use, whereas older age (OR 0.74 [0.64-0.86] per 5 year increase) and prior revascularization (OR 0.73 [0.55-0.99]) were associated with lower likelihood of SCM use within 90 days post-MI.
Conclusions: Despite prevalent smoking cessation counseling, we observed low rates of prescription SCM use in this national study of elderly MI patients who were recent smokers. These results suggest substantial room for improvement in intensifying peri-discharge smoking cessation interventions for secondary prevention.
Author Disclosures: N.J. Pagidipati: Ownership Interest; Significant; Freedom Health, Inc, Physician Partners, LLC, RXAdvance LLC, Florida Medical Associates, LLC. A. Hellkamp: None. L. Thomas: None. M. Gulati: None. E. Peterson: Research Grant; Significant; Janssen Pharmaceutical Products. Consultant/Advisory Board; Modest; Janssen Pharmaceutical Products, Regeneron Pharmaceuticals Inc, Sanofi-Aventis. Consultant/Advisory Board; Significant; AstraZeneca, Bayer Corporation US, Boehringer Ingelheim, Merck & Co, Valeant. T. Wang: Research Grant; Modest; Gilead Sciences, Eli Lilly, Daiichi Sanyo, Astra Zeneca, Boston Scientific, Regeneron, GlaxoSmithKline. Honoraria; Modest; Astra Zeneca, Eli Lilly, Pfizer.
- © 2016 by American Heart Association, Inc.