Conference Coverage

VIDEO: Start varenicline during hospitalization for heart attack




ORLANDO – Initiating varenicline while smokers are hospitalized for acute coronary syndrome (ACS) is an effective strategy for boosting 6-month smoking abstinence rates in this extremely high–cardiovascular risk population, Dr. Mark J. Eisenberg said in an interview at the American Heart Association scientific sessions.

At the meeting, Dr. Eisenberg presented the results of the EVITA trial, a multicenter, randomized, double-blind study of 303 U.S. and Canadian patients, all longtime smokers, who began a 12-week course of varenicline (Chantix) at 1 mg twice daily or placebo while hospitalized for ACS. Participants had been smokers for an average of 36 years and smoked 22 cigarettes per day at the time of their ACS.

The 24-week rate of biochemically confirmed abstinence in the placebo group was 32.5%. That’s typical. Numerous studies have shown that less than one-third of smokers remain abstinent once discharged from the hospital following an ACS.

In contrast, the 24-week abstinence rate in the varenicline group was 47.3%. The number needed to treat with varenicline to achieve one additional quitter through 6 months of follow-up was 6.8, according to Dr. Eisenberg, professor of medicine at McGill University and director of the cardiovascular health services research program at Jewish General Hospital, both in Montreal.

Observers hailed this as a practice-changing study, and Dr. Eisenberg concurred. Noting that cardiologists are already comfortable in starting ACS patients on statins, beta-blockers, and aspirin while in hospital, he predicted physicians will seize this unique opportunity to help patients quit smoking as well.

“This is a teachable moment,” Dr. Eisenberg observed. “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 smoking.”

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