The efficacy of smoking cessation therapies in cardiac patients: A meta-analysis of randomized controlled trials

• Published in: Canadian journal of cardiology 2010-02, Vol.26 (2), p.73-79
• Main Authors: Eisenberg, Mark J., MD MPH, Blum, Lisa M., BA, Filion, Kristian B., Msc, Rinfret, Stephane, MD MSc FRCPC, Pilote, Louise, MD MPH PhD, Paradis, Gilles, MD MSc, Joseph, Lawrence, PhD, Gervais, André, MD FRCPC, O’Loughlin, Jennifer, PhD
• Format: Article
• Language: English
• Subjects: Antidepressive Agents, Second-Generation - therapeutic use; Behavior Therapy - methods; Behavioural therapy; Bupropion - therapeutic use; Cardiac patients; Cardiovascular; Cardiovascular Diseases - prevention & control; Clinical Studies; Humans; Randomized Controlled Trials as Topic; Smoking - adverse effects; Smoking cessation; Smoking Cessation - methods; Smoking cessation pharmacotherapy; Treatment Outcome
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/S0828-282X(10)70002-7

Introduction Several meta-analyses have examined the efficacy of smoking cessation therapies in the general population. However, little is known about the efficacy of these therapies in cardiac patients. Therefore, a meta-analysis of randomized controlled trials (RCTs) was performed to determine the efficacy of behavioural therapy and pharmacotherapy for smoking cessation in cardiac patients. Methods The medical literature was systematically reviewed to identify smoking cessation RCTs in cardiac patients. Only RCTs that reported smoking abstinence at six or 12 months were included. Smoking abstinence was examined based on the ‘most rigorous criterion’, defined as the most conservative outcome reported in any given RCT. Results Eleven behavioural therapy RCTs that enrolled 2105 patients and four pharmacotherapy RCTs that enrolled 1542 patients were identified. RCTs differed in the type of behavioural therapy administered as well as the total length and duration of the intervention. RCTs differed in the type of pharmacotherapy administered (one nicotine patch RCT, one nicotine gum RCT and two bupropion RCTs). Behavioural therapy was associated with a significantly higher proportion of smoking abstinence than usual care (OR 1.97 [95% CI 1.37 to 2.85]). Pharmacotherapies were more efficacious than placebo (pooled OR 1.72 [95% CI 1.15 to 2.57]). Conclusions Both behavioural therapy and pharmacotherapy are more efficacious than usual care for smoking cessation in cardiac patients. The present meta-analysis highlights the need for head-to-head RCTs to identify which smoking cessation therapy is preferred in cardiac patients as well as RCTs examining the efficacy of combined behavioural and pharmacotherapies.