59 Real world experience of nicotine replacement therapy (NRT) following st elevation myocardial infarction (STEMI): does prescription limit smoking cessation (SC) success?

Introduction An admission with STEMI is a powerful motivating event for SC with successful patients adding an average of five healthy years of life compared to ongoing smokers. Continuing smokers are also 4 times more likely to suffer from recurrent myocardial infarction. NRT has been shown to improve SC in out-patient settings, however in a STEMI cohort, might reintroduce nicotine after a period of inpatient abstinence, thereby confounding efforts to give up. The safety of NRT in STEMI patients has been demonstrated, however the efficacy of NRT compared to advice and support and nicotine abstinence has not been fully tested. The aim of this study is to investigate the impact of NRT on smoking cessation success in patients admitted with STEMI. Methods We assessed STEMI patients admitted to a large regional heart attack centre who were smokers at the time of admission. We grouped patients by prescription of NRT as an in-patient (NRT group) and those without prescription (No NRT). All patients were then followed up to determine smoking status at varying timepoints in clinic, cardiac rehabilitation or by telephone (Mean time to follow up 9 months, STDEV 8 Months) Results From December 2020 to December 2022, 124 (31 Females, 25%, 18 diabetic, 14.5%) active smokers suffering STEMI were admitted. 55 patients (44%) received NRT, 69 (56%). did not (no NRT). The Mean age of participants was 59 (range 31–84 years). Mean (STDEV) follow time for the NRT group was 10 months (8), and for the No-NRT group was 8 months (8). In the NRT group 30/55 (54.5%) were actively smoking at follow up, whereas in the No NRT group 22/69 (31.9%) were smoking at follow up (P=0.017). Conclusion A STEMI is an important life changing occurrence in a patient's life which can provide a powerful motivation to quit smoking. Patients typically have a valuable nicotine free period during their index admission. It is possible that the introduction of nicotine as a therapy during this admission is counterproductive. In our cohort, NRT prescription was associated with a significantly higher risk of smoking at follow up. These results are subject to a number of confounding variables, but are hypothesis generating and suggest that further, large scale studies in this very high-risk group are warranted. Conflict of Interest None