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    EVITA: Varenicline Started in ACS Hospitalization Can Help Smokers Quit

    The smoking-cessation drug varenicline (Chantix/Champix, Pfizer), which has been shown to work in patients with stable coronary disease, can also help those hospitalized with acute coronary syndromes to kick the habit, according to researchers based on their randomized, controlled trial[1].

    In the Evaluation of Varenicline in Smoking Cessation for Patients Post-Acute Coronary Syndrome (EVITA) trial, patients who were smokers and who started on varenicline while hospitalized for ACS were significantly more likely than a control group to be smoking-abstinent 24 weeks later. The smoking-cessation intervention also included "low-intensity counseling," a mean of 46 minutes total for the entire trial.

    "Our results are important because clinical trials have not examined the efficacy of nicotine-replacement therapy in this patient population and because several trials of bupropion in these patients suggest that it is not efficacious," observe Dr Mark J Eisenberg, Jewish General Hospital/McGill University, Montreal, QC) and colleagues. Their report is published today in Circulation to coincide with Eisenberg"s scheduled EVITA presentation here at the American Heart Association (AHA) 2015 Scientific Sessions.

    Success in a Challenging Patient Population

    "Without smoking-cessation therapy, less than a third of smokers hospitalized with acute coronary syndrome remain abstinent after discharge," Eisenberg said for heartwire from Medscape. "And in fact, the numbers that I"m presenting today are probably much better than they are in real life, because many patients are not motivated to quit—not even willing to take medication for smoking cessation."

    EVITA is, he said, "I think, the first trial with a clinical therapy started in the hospital that looks like it"s effective for smoking cessation in ACS patients."

    Dr David A Wood (National Heart & Lung Institute, Imperial College London, UK), who isn"t an EVITA investigator, sees an opportunity in the predischarge setting to double-down on smoking-cessation medications. "Patients with ACS stop smoking, for the most part, obviously, in the hospital. And so the question is, can you prevent them from relapsing once they leave?" he said to heartwire .

    "Managing withdrawal with nicotine-replacement therapy in-hospital in the context of ACS is extremely important in addition to, based on this trial, starting varenicline to prevent relapse," according to Wood.

    "Varenicline will reduce the craving for cigarettes, but the impact is not immediate. Using nicotine-replacement therapy will immediately affect that craving. So the combination of the two may be very powerful."

    ACS hospitalization is a special opportunity in other ways for getting patients off cigarettes in that it represents a powerful "teachable moment," emphasized Dr Donald Lloyd-Jones (Northwestern University Feinberg School of Medicine, Chicago, IL), also not with EVITA. The trial, he told heartwire , produced "very good results," but there were just 12 weeks of therapy, "so it does require follow-up if we want to sustain it."

    Eisenberg acknowledged that the difference in smoking-abstinence rates between the two groups in the trial attenuated a bit between 12 and 24 weeks, but "it"s normal in all smoking-cessation trials that there"s a tapering off as we go."


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