Background: Little is known about the safety of nicotine replacement therapy (NRT) in smokers hospitalized with acute coronary heart disease (CHD).
Methods: We examined the safety of NRT use among smokers hospitalized for CHD in a geographically and structurally diverse sample of US hospitals in the year 2014. We compared smokers who received NRT to smokers who did not and adjusted for baseline differences through the use of propensity score matching. Outcomes included inpatient mortality, hospital length of stay, total hospitalization costs, and 1-month readmission.
Results: From 270 hospitals, we included 27,459 smokers (mean age 58.6 yrs., 69% male, 56.9% in intensive care unit) of whom 4885 (17.8%) received NRT (97.2% used the nicotine patch, at a median dose of 21 mg/day for 3 days). After propensity matching, covariates were well-balanced within each patient group. Among patients with myocardial infarction, compared to patients who did not receive NRT, those who received NRT showed no difference in mortality (2.3% vs 2.1%, p = 0.98), mean length of stay (4.3 ± 3.3 vs. 4.4 ± 3.5 days, p = 0.60), mean cost ($10,428 ± 8,814 vs. $10,502 ± 8,731, p = 0.57), or 1-month readmission (14.6% vs 15.8%, p = 0.31). Results were similar for patients undergoing percutaneous coronary intervention or coronary artery bypass surgery.
Conclusions: Among smokers hospitalized with acute CHD, use of NRT was not associated with worse short-term outcomes. Given the beneficial effects of NRT in treating nicotine withdrawal, reducing cravings, and promoting smoking cessation after discharge, our findings suggest that NRT is a safe and reasonable treatment option.