Very low rate of early use of prescription smoking cessation medications among older patients after heart attack

The immediate period after a myocardial infarction (MI; heart attack) represents a unique window of opportunity to encourage patients to quit smoking. Using data (from between April 2007 and December 2013) from a large MI registry, Neha J. Pagidipati, M.D., M.P.H., of Duke University, Durham, N.C., and colleagues examined patient factors associated with early prescription smoking cessation medication (SCM) use (defined as filling of a prescription within 90 days postdischarge or supply remaining from a pre-admission fill). Prescription SCMs included in the study were bupropion and varenicline.

Among the 9,193 smoking patients (median age, 70 years) with MI in this analysis, 97 percent received smoking cessation counseling during their hospitalization, yet only 7 percent had early-prescription SCM use (bupropion, 47 percent; varenicline, 53 percent). Varenicline use dropped from 12.6 percent in 2007 to 2.2 percent in 2013; bupropion use stayed consistently low (2.5 percent in 2007, 3.2 percent in 2013). The median duration of use was 6.2 weeks for bupropion and 4.3 weeks for varenicline (the typically recommended course is 12 weeks).

Factors associated with early SCM use: being younger; female; living in counties with greater than the median high school graduate rate; having chronic lung disease; having undergone in-hospital coronary revascularization; having peripheral arterial disease.

Limitations of the study included the lack of data about actual prescription rates, smoking cessation rates post-MI, or reasons for drug prescription or discontinuation.

"Because individuals who successfully quit smoking do so most frequently in the immediate post-MI period, current practices indicate a missed opportunity for smoking cessation and secondary prevention efforts," the authors write.