Short‐Term Safety of Nicotine Replacement in Smokers Hospitalized With Coronary Heart Disease

Abstract

BackgroundLittle is known about the safety of nicotine replacement therapy (NRT) in smokers hospitalized with coronary heart disease.Methods and ResultsWe examined the short‐term safety of NRT use among smokers hospitalized for coronary heart disease in a geographically and structurally diverse sample of US hospitals in the year 2014. We compared smokers who started NRT in the first 2 days of hospitalization with smokers without any exposure to NRT and adjusted for baseline differences through propensity score matching. Outcomes included inpatient mortality, hospital length of stay, and 1‐month readmission. From 270 hospitals, we included 27 459 smokers (mean age, 58 years; 69% men; 56.9% in intensive care unit), of whom 4885 (17.8%) received NRT (97.2% used the nicotine patch, at a median dose of 21 mg/d for 3 days). After propensity matching, covariates were well balanced within each patient group. Among patients with myocardial infarction, compared with patients who did not receive NRT, those who received NRT showed no difference in mortality (2.1% versus 2.3%; P=0.98), mean length of stay (4.4±3.5 versus 4.3±3.3 days; P=0.60), or 1‐month readmission (15.8% versus 14.6%; P=0.31). Results were similar for patients undergoing percutaneous coronary intervention or coronary artery bypass surgery.ConclusionsAmong smokers hospitalized for treatment of coronary heart disease, use of NRT was not associated with any differences in short‐term outcomes. Given the known beneficial effects of NRT in treating nicotine withdrawal, reducing cravings, and promoting smoking cessation after discharge, our findings suggest that NRT is a safe and reasonable treatment option.

Current advances in research in treatment and recovery: Nicotine addiction

“…Cigarette smoke delivers not only nicotine but also many oxidants, prothrombotic and other toxic chemicals, making smoking much more toxic than nicotine alone. Clinical trials and other studies of NRT in patients with cardiovascular disease find no increase in adverse cardiovascular events due to NRT ( 139 , 140 ).…”

Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

“…Previous research indicates that, although providers recognize the benefits of SCM/NRT, they are reluctant to implement these treatments due to lack of knowledge and prescribing experience, concerns surrounding the financial implication of providing NRT to patients, and the possibility of liability and legal implications . However, recent literature indicates that lingering safety concerns surrounding the use of SCM and NRT no longer appear justified . Additionally, failure to provide SC counseling has often been attributed to competing priorities and busy work, but this common notion is not generally supported by empirical research and appears to be more a reflection of physician priorities.…”

“…29 However, recent literature indicates that lingering safety concerns surrounding the use of SCM and NRT no longer appear justified. 30,31 Additionally, failure to provide SC counseling has often been attributed to competing priorities and busy work, but this common notion is not generally supported by empirical research 32 and appears to be more a reflection of physician priorities. Thus, we believe that engaging patients during key teachable moments, such as hospitalization, should be a priority among all clinicians in an effort to eliminate their patients most significant risk factor for heart disease.…”

Anesthesiologists and the Other Pandemic: Tobacco Use

“…114,115 The overall safety profile of nicotine replacement therapy is excellent, even in patients with significant comorbidity such as cardiovascular disease. 116,117 Approved first-line non-nicotine medications include bupropion and varenicline. 115 Bupropion is an atypical antidepressant that blocks norepinephrine and dopamine reuptake in the mesolimbic system and may also act as an antagonist of nicotinic receptors.…”