EFFECTIVENESS AND PREDICTORS OF A SMOKING CESSATION PROGRAM IN PATIENTS WITH CARDIOVASCULAR DISEASE: SEX AND AFFORDABILITY MATTER
CCC ePoster Library. Gonzaga-Carvalho C. 10/26/19; 280536; 301
Dr. Carolina Gonzaga-Carvalho
Dr. Carolina Gonzaga-Carvalho
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Abstract
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BACKGROUND: Tobacco smoking is the leading cause of preventable death around the world. While smoking cessation (SC) programs have helped patients to quit smoking, success rates vary. This study evaluates clinical characteristics and predictors of success in quitting or reducing smoking of patients attending a SC clinic in an inner-city tertiary cardiac center.

METHODS AND RESULTS: Retrospective chart review of consecutive patients who attended the SC program from 2008 to 2018. All subjects attended at least two visits, receiving individualized medical counseling, and if necessary, prescription of medications according to patient's preference and contraindications. Patients were divided into NQ-NR (neither quit or reduced smoked cigarettes in ≥ 50%), R (reduce smoking by > 50% and < 100%), and Quit smoking groups. Logistic regression assessed the association of age, sex, presence of comorbidities, total number of visits, medication affordability, and varenicline use, with quitting or reducing smoking by > 50%. p-value < 0.05 was considered significant. In total, 233 patients (age 56±12 years, 35% female) were included, reporting smoking 18±16 cigarettes per day, for 37±14 years. After mean follow-up of 6±8 months (5±5 visits), NQ-NR, R, and Quit groups exhibited 107 (46%), 68 (29%), and 58 (25%) patients, respectively. Clinical history of dyslipidemia (66%), hypertension (66%), diabetes (28%), coronary artery disease (44%), peripheral artery disease/aortic disease (16%), stroke/transitory ischemic attack (5%), lung disorders (24%), depression/anxiety (28%), cannabis use (14%), and number of medications (5±3) were similar between groups. Prescription of nicotine replacement (patch (51%), gum/lozenge (31%), inhaler/spray (34%)) and bupropion (22%) were similar between groups. Patients who quit smoking had varenicline more frequently prescribed than those in NQ-NR group (38% vs. 16%, p = 0.003). Nineteen patients (8%) described affordability issues. After logistic regression, total number of visits (OR 6.35, 95% CI 2.0-19.9, p = 0.002), varenicline use (OR 2.40, 95% CI 1.2-4.7, p = 0.012), female sex (OR 0.49, 95% CI 0.27-0.89, p = 0.019), and issues to afford medications (OR 0.33, 95% CI 0.11-0.98, p = 0.047), remained independently associated with quitting or reducing smoking by > 50%.

CONCLUSION: SC and harm reduction rates of 54% were achievable despite the presence of comorbidities. While total number of visits and varenicline use were associated with higher rates of success, female sex and medication affordability were predictors of lack of success. This supports the use of SC clinics for patients with cardiovascular disease and multicomorbidities, and further understanding of sex-specific needs.
BACKGROUND: Tobacco smoking is the leading cause of preventable death around the world. While smoking cessation (SC) programs have helped patients to quit smoking, success rates vary. This study evaluates clinical characteristics and predictors of success in quitting or reducing smoking of patients attending a SC clinic in an inner-city tertiary cardiac center.

METHODS AND RESULTS: Retrospective chart review of consecutive patients who attended the SC program from 2008 to 2018. All subjects attended at least two visits, receiving individualized medical counseling, and if necessary, prescription of medications according to patient's preference and contraindications. Patients were divided into NQ-NR (neither quit or reduced smoked cigarettes in ≥ 50%), R (reduce smoking by > 50% and < 100%), and Quit smoking groups. Logistic regression assessed the association of age, sex, presence of comorbidities, total number of visits, medication affordability, and varenicline use, with quitting or reducing smoking by > 50%. p-value < 0.05 was considered significant. In total, 233 patients (age 56±12 years, 35% female) were included, reporting smoking 18±16 cigarettes per day, for 37±14 years. After mean follow-up of 6±8 months (5±5 visits), NQ-NR, R, and Quit groups exhibited 107 (46%), 68 (29%), and 58 (25%) patients, respectively. Clinical history of dyslipidemia (66%), hypertension (66%), diabetes (28%), coronary artery disease (44%), peripheral artery disease/aortic disease (16%), stroke/transitory ischemic attack (5%), lung disorders (24%), depression/anxiety (28%), cannabis use (14%), and number of medications (5±3) were similar between groups. Prescription of nicotine replacement (patch (51%), gum/lozenge (31%), inhaler/spray (34%)) and bupropion (22%) were similar between groups. Patients who quit smoking had varenicline more frequently prescribed than those in NQ-NR group (38% vs. 16%, p = 0.003). Nineteen patients (8%) described affordability issues. After logistic regression, total number of visits (OR 6.35, 95% CI 2.0-19.9, p = 0.002), varenicline use (OR 2.40, 95% CI 1.2-4.7, p = 0.012), female sex (OR 0.49, 95% CI 0.27-0.89, p = 0.019), and issues to afford medications (OR 0.33, 95% CI 0.11-0.98, p = 0.047), remained independently associated with quitting or reducing smoking by > 50%.

CONCLUSION: SC and harm reduction rates of 54% were achievable despite the presence of comorbidities. While total number of visits and varenicline use were associated with higher rates of success, female sex and medication affordability were predictors of lack of success. This supports the use of SC clinics for patients with cardiovascular disease and multicomorbidities, and further understanding of sex-specific needs.
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