September 18, 2018
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Nicotine replacement therapy safe for smokers hospitalized with CHD

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The short-term use of nicotine replacement therapy among smokers hospitalized for CHD did not affect rates of mortality, length of stay or 1-month readmission, suggesting it is a safe treatment option, according to a study published in the Journal of the American Heart Association.

“For years, clinicians have wondered about the safety of nicotine replacement therapy among smokers who are having a heart attack,” Quinn R. Pack, MD, MSc, preventive cardiologist and medical director of cardiac rehabilitation and wellness at the University of Massachusetts Medical School – Baystate, told Cardiology Today. “While prior studies have shown that nicotine replacement therapy is safe as an outpatient and after a hospitalization, our study is the first to show that nicotine replacement therapy has no apparent safety problems when used within the first 2 days of a heart attack, heart stenting procedure or coronary artery bypass surgery.”

The researchers conducted a retrospective cohort study of 270 U.S. hospitals that were participating in the Premier Healthcare Inpatient Database Alliance, a diverse group of hospitals that captures about 15% to 20% of inpatient hospitalizations, in 2014. Smokers who were admitted with a principal diagnosis of MI or received PCI or CABG (n = 27,459; mean age, 57 years; 70% men; 56.9% in the ICU) were divided into one of three categories: those with acute MI that was medically managed; those who underwent PCI with or without MI; or those who received CABG with or without MI or PCI.

Therapy not harmful

Within the first 2 days of hospitalization, some form of nicotine replacement therapy — most commonly the nicotine patch at a median daily dose of 21 mg per day for a median of 3 days — was given to 17.8% of participants.

After propensity matching, the researchers found no significant difference in rates of mortality, length of stay or 1-month readmission between patients who had received nicotine replacement therapy and those who did not.

For patients with MI, in-hospital mortality was 2.3% in those who were given nicotine replacement therapy and 2.1% in those who did not receive the therapy (P = .98), and the mean length of stay was 4.4 days for patients with MI given the therapy and 4.3 in those who were not (P = .6). In addition, 14.6% of patients given the therapy and 15.8% of those not given the therapy were readmitted within 30 days (P = .31).

Results were similar in the PCI group and the CABG group.

Treatment encouraged

Because nicotine replacement therapy can treat withdrawal, reduce cravings and help smokers quit long term, the findings imply that all patients should be offered — and even encouraged — to start treatment for nicotine addiction while in the hospital, according to Pack. Furthermore, he said, the results suggest that physicians are able to treat patients with the therapy without concern for inducing adverse events.

“Only 20% to 25% of patients got any kind of treatment for their smoking addiction, despite the strong impact that smoking has on heart disease,” Pack said. “Thus, the main need for research in this area is to better understand how to get more people treated with these effective medications. This would include understanding how to help physicians counsel and prescribe these medications for every single patient that smokes.” – by Melissa J. Webb

For more information:

Quinn R. Pack, MD, MSc, can be reached at quinn.packmd@baystatehealth.org.

Disclosures: The authors report no relevant financial disclosures.