Magazine article Clinical Psychiatry News

Varenicline in Hospital Boosts Smoking Quit Rates

Magazine article Clinical Psychiatry News

Varenicline in Hospital Boosts Smoking Quit Rates

Article excerpt

AT THE AHA SCIENTIFIC SESSIONS

ORLANDO -- Starting varenicline in smokers while hospitalized for an acute coronary syndrome resulted in substantially higher smoking abstinence rates than with placebo at all time points through 6 months of follow-up in the double-blind, randomized EVITA trial.

"The ACS population is typically older, they're long-term smokers, and they come into the hospital with a life-threatening condition. Their family is all around them. They've had angioplasty or CABG [coronary artery bypass graft] surgery. So they have pressure on them to stop smoking. This is a teachable moment, a window of opportunity. The public health benefit for smoking cessation in this population is huge. You can cut their risk of death and significant morbidity in half if you can get them to stop," Dr. MarkJ. Eisenberg said in presenting the EVITA results at the American Heart Association scientific sessions.

EVITA (Evaluation of Varenicline in Smoking Cessation for Patients Post-Acute Coronary Syndrome) was an investigator-initiated, 40-center study involving 302 smokers hospitalized for ACS. They'd smoked for an average of 36 years and were puffing 22 cigarettes per day at enrollment. More than 90% of them had an acute MI just several days before starting on varenicline (Chantix) at 1 mg twice daily or placebo for 12 weeks.

"To our knowledge, this is the highest-risk population that's been exposed to varenicline," said Dr. Eisenberg, professor of medicine at McGill University and director of the cardiovascular health services research program at Jewish General Hospital in Montreal.

The primary study endpoint was continuous self-reported abstinence since baseline backed by biochemical confirmation in the form of an exhaled carbon monoxide level of 10 ppm or less at week 24 as well as at all the earlier follow-up visits. The rate was 47.3% in the varenicline group, compared with 32.5% in placebo-treated controls.

That placebo response rate is in line with numerous prior studies that have shown that less than one-third of smokers with ACS remain abstinent after leaving the hospital.

"Most cardiologists would say, All my patients stop smoking.' But in the clinic if you look in the patients' pockets, you find a pack of cigarettes. They stop smoking while in hospital, but as soon as they're discharged, the relapse rate is almost immediate. Most patients are smoking the day they get out of hospital," according to Dr. Eisenberg.

In EVITA, the number-needed-to-treat with varenicline for 12 weeks in order to produce 1 extra nonsmoker at 6 months was 6. …

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