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Review
. 2010 Feb;26(2):73-9.
doi: 10.1016/s0828-282x(10)70002-7.

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

Mark J Eisenberg  1 , Lisa M Blum, Kristian B Filion, Stephane Rinfret, Louise Pilote, Gilles Paradis, Lawrence Joseph, André Gervais, Jennifer O'Loughlin
Affiliations
Review

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

Mark J Eisenberg et al. Can J Cardiol. 2010 Feb.

Abstract
in English, French

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.

INTRODUCTION :: Plusieurs méta-analyses se sont penchées sur l’efficacité des mesures antitabagiques dans la population générale. Par contre, on en connaît peu sur l’efficacité de ces stratégies chez les patients cardiaques. C’est pourquoi on a procédé à une méta-analyse des essais randomisés et contrôlés (ERC) afin de mesurer l’efficacité des approches antitabagiques comportementales et pharmacothérapeutiques chez les patients cardiaques.

MÉTHODES :: Les auteurs ont passé en revue systématiquement la littérature médicale afin de relever les ERC ayant porté sur l’abandon du tabagisme chez des patients cardiaques. Les auteurs n’ont retenu que les ERC qui faisaient état d’une abstinence d’une durée de six ou 12 mois. L’abstinence a été analysée en fonction du critère le plus rigoureux défini par le paramètre le plus conservateur signalé parmi tous les ERC.

RÉSULTATS :: Les auteurs ont retenu 11 ERC portant sur une approche comportementale qui regroupaient 2 105 patients et quatre ERC portant sur une approche pharmacothérapeutique qui regroupaient 1 542 patients. Les premiers différaient quant à l’approche comportementale utilisée et quant à la durée totale de l’intervention. Les seconds différaient quant au type de pharmacothérapie administrée (un, portait sur un timbre de nicotine, un, sur une gomme de nicotine et deux, sur le bupropion). L’approche comportementale a été associée à une proportion significativement plus élevée d’abstinence par rapport à l’approche habituelle (RC 1,97 [IC à 95 %, 1,37 à 2,85]). Les pharmacothérapies ont été plus efficaces que le placebo (RC regroupé 1,72 [IC à 95 %, 1,15 à 2,57]).

CONCLUSIONS :: Les approches comportementales et pharmacothérapeutiques favorisent plus efficacement l’abandon tabagique que les approches habituelles chez les patients cardiaques. La présente méta-analyse rappelle la nécessité de réaliser d’une part, des ERC comparatifs directs pour déterminer quelle approche antitabagique convient le mieux aux patients cardiaques et d’autre part, des ERC pour vérifier l’efficacité des approches comportementales et pharmacothérapeutiques utilisées concomitamment.

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Figures

Figure 1)
Figure 1)
Flow diagram of randomized controlled trials (RCTs) included in the meta-analysis
Figure 2)
Figure 2)
Meta-analysis of randomized controlled trials (RCTs) examining the efficacy of smoking cessation behavioural therapy compared with usual care in cardiac patients. Smoking abstinence was examined with respect to the ‘most rigorous criterion’ of abstinence reported, defined as the most conservative outcome reported in any given RCT, based on the following ranking: 1 – continuous abstinence at 12 months; 2 – continuous abstinence at six months; 3 – point prevalence at 12 months; 4 – point prevalence at six months
Figure 3)
Figure 3)
Meta-analysis of randomized controlled trials (RCTs) examining the efficacy of smoking cessation pharmacotherapy compared with placebo in cardiac patients. Smoking abstinence was examined with respect to the ‘most rigorous criterion’ of abstinence reported, defined as the most conservative outcome reported in any given RCT, based on the following ranking: 1 – continuous abstinence at 12 months; 2 – continuous abstinence at six months; 3 – point prevalence at 12 months; 4 – point prevalence at six months
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