title: Prevalence and correlates of smoking cessation pharmacotherapy in hospitalized smokers with acute myocardial infarction.
abstract: BACKGROUND
  Although current performance measures recommend smoking cessation counseling at the time of acute myocardial infarction (AMI), the American College of Cardiology/American Heart Association guidelines recommend pharmacotherapy as well. The aim of this study was to describe the prevalence and correlates of smoking cessation pharmacotherapy in hospitalized patients with AMI.
  
  
  METHODS
  In the 24-center TRIUMPH registry, 4,340 AMI patients underwent detailed interviews; and 1,631 reported smoking within 30 days of admission. Prescription of first-line smoking cessation medications at discharge was assessed by medical record review. All patient-related factors associated with smoking cessation treatment, based on literature review, were included in hierarchical modified log Poisson models.
  
  
  RESULTS
  Only 14% (222/1,631) of AMI patients who smoked were prescribed smoking cessation medication at discharge. After multivariable adjustment for patient characteristics, there was significant variation across sites (range 0%-28%, median rate ratio 1.41, 95% CI 1.23-2.67). Independent factors associated with smoking cessation pharmacotherapy included older age (rate ratio 0.81 per 10-year increment, 95% CI 0.71-0.93), high school graduation (rate ratio 1.37, 95% CI 1.10-1.66), heavy cigarette usage (>20/d) (rate ratio 3.08, 95% CI 2.20-4.12), in-hospital revascularization (rate ratio 1.41, 95% CI 1.0-1.94), and instructions on smoking cessation (rate ratio 2.37, 95% CI 1.40-4.01).
  
  
  CONCLUSIONS
  Smokers surviving an AMI are infrequently prescribed guideline-recommended smoking cessation treatments, and there is considerable variation across hospitals. Older, less educated, and lighter smokers are less likely to receive aggressive smoking cessation treatment. Novel strategies to augment current practice are needed.
authors: University of Iowa Carver College of Medicine and Iowa City VA Hospital, Iowa City, IA 52246-2208, USA. david-katz@uiowa.edu
authors: David A
authors: DA
authors: Katz
authors: Fengming
authors: F
authors: Tang
authors: Babalola
authors: B
authors: Faseru
authors: Phillip A
authors: PA
authors: Horwitz
authors: Philip
authors: P
authors: Jones
authors: John
authors: J
authors: Spertus
mesh_terms: D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D015995:Prevalence; D012189:Retrospective Studies; D012907:Smoking / Q000188:drug therapy* / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D018722:Nicotinic Agonists