Abstract P340: Prevalence and Correlates of Smoking Cessation Pharmacotherapy in Hospitalized Smokers With Acute Myocardial Infarction

Background ACC/AHA guidelines recommend pharmacotherapy for smoking cessation in smokers with AMI. The aim of this study was to determine the prevalence of smoking cessation pharmacotherapy in hospitalized patients with AMI and to identify patient factors associated with prescription of these medications. Methods In the 24-center TRIUMPH registry, 4340 AMI patients underwent detailed interviews and 1631 reported smoking within 30 days of admission. Prescription of first-line smoking cessation medications at discharge was assessed by medical record review. All factors associated with smoking cessation treatment based on literature review were included in hierarchical modified log Poisson models. Results Only 14% (222/1631) of AMI patients who smoked were prescribed smoking cessation medication at discharge. Younger age, high school graduation, heavy cigarette usage, and treatment variables (instruction on smoking cessation, in-hospital revascularization) were independently associated with prescription of smoking cessation pharmacotherapy (see Figure). There was significant variation in prescribing across sites: range: 0-28%, median rate ratio 1.42 (1.24, 2.70) after multivariable adjustment. Conclusions Smokers surviving an AMI are rarely prescribed recommended smoking cessation treatment and there is considerable variation in prescription rates among hospitals. Although inpatient cessation counseling alone has not been shown to increase cessation rates in AMI patients, it increases the likelihood that patients receive effective pharmacotherapy. More aggressive use of pharmacotherapy is justified in older, less educated, and lighter smokers.