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• W4318922866 abstract "HomeStrokeVol. 54, No. 3Smoking-Cessation Pharmacotherapy After Stroke and Transient Ischemic Attack: A Get With The Guidelines-Stroke Analysis Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBSmoking-Cessation Pharmacotherapy After Stroke and Transient Ischemic Attack: A Get With The Guidelines-Stroke Analysis Neal S. Parikh, Cenai Zhang, Setareh Salehi Omran, Daniel Restifo, Matthew J. Carpenter, Lee Schwamm and Hooman Kamel Neal S. ParikhNeal S. Parikh Correspondence to: Neal S. Parikh, Department of Neurology, Weill Cornell Medicine, 420 E 70th St, LH408, New York, NY 10021. Email E-mail Address: [email protected] https://orcid.org/0000-0002-8802-2380 Clinical and Translational Neuroscience Unit, Weill Cornell Medicine, New York (N.S.P., C.Z., D.R., H.K.). Search for more papers by this author , Cenai ZhangCenai Zhang https://orcid.org/0000-0001-8137-1644 Clinical and Translational Neuroscience Unit, Weill Cornell Medicine, New York (N.S.P., C.Z., D.R., H.K.). Search for more papers by this author , Setareh Salehi OmranSetareh Salehi Omran https://orcid.org/0000-0002-3184-5327 Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O.). Search for more papers by this author , Daniel RestifoDaniel Restifo https://orcid.org/0000-0003-1963-0742 Clinical and Translational Neuroscience Unit, Weill Cornell Medicine, New York (N.S.P., C.Z., D.R., H.K.). Search for more papers by this author , Matthew J. CarpenterMatthew J. Carpenter https://orcid.org/0000-0002-8909-1302 Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston (M.J.C.). Search for more papers by this author , Lee SchwammLee Schwamm https://orcid.org/0000-0003-0592-9145 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.S.). Search for more papers by this author and Hooman KamelHooman Kamel https://orcid.org/0000-0002-5745-0307 Clinical and Translational Neuroscience Unit, Weill Cornell Medicine, New York (N.S.P., C.Z., D.R., H.K.). Search for more papers by this author Originally published2 Feb 2023https://doi.org/10.1161/STROKEAHA.122.041532Stroke. 2023;54:e63–e65Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 2, 2023: Ahead of Print Smoking-cessation rates after stroke are suboptimal.1 Smoking-cessation medications—nicotine replacement therapy, varenicline, and bupropion—significantly increase the likelihood of successful abstinence, compared to counseling alone.2 We aimed to assess rates and predictors of cessation medication provision after stroke and transient ischemic attack (TIA) in the United States, and hypothesized that patients with hemorrhagic stroke and TIA are less often given such treatments than patients with ischemic stroke.This is a retrospective, cross-sectional study using data from the Get With The Guidelines-Stroke registry, an American Heart Association/American Stroke Association initiative (Supplemental Methods). We included active smokers with ischemic stroke, hemorrhagic stroke, and TIA from 2018 through 2020. We categorized patients as those who received any cessation medication versus none. Multivariable logistic regression assessed factors associated with cessation medication; models included variables significantly associated with provision in univariate analyses after Bonferroni correction.We included 106 714 smokers with stroke/TIA. The mean age was 60 years (SD, 12) and 42% were women; 81.2% had ischemic stroke, 9.5% hemorrhagic stroke, and 9.2% TIA. Overall, 17.5% were smokers (ischemic stroke, 18.9%; hemorrhagic stroke, 14.9%; TIA, 12.4%). Altogether, cessation medication was provided to 29.8% of patients (nicotine replacement therapy, 16.2%; varenicline or bupropion, 13.0%; multiple/other, 2.3%); the remainder received counseling alone (Table S1). Proportions differed by event type: ischemic stroke (31.0%), hemorrhagic stroke (26.7%), and TIA (23.6%; Figure). Patients who received cessation medication versus counseling alone had similar age, sex, and comorbidities (Table S2). Stratified analyses and univariate models identified several patient-level and care-level factors associated with cessation medication provision (Table S3). In multivariable models, hemorrhagic stroke (odds ratio [OR], 0.81 [95% CI, 0.76–0.86]) and TIA (OR, 0.68 [95% CI, 0.64–0.73]) were associated with lower odds of cessation medication provision, compared to ischemic stroke. Additionally, Black (OR, 0.78 [95% CI, 0.74–0.82]) and Asian (OR, 0.72 [95% CI, 0.58–0.87]) patients had lower odds of receiving cessation medication, compared to White patients. Hispanic ethnicity was also associated with lower odds of cessation medication provision (OR, 0.65 [95% CI, 0.56–0.73]; Figure). Additional data for subarachnoid and intracerebral hemorrhage, and analyses addressing missingness, are provided separately (Supplemental Results).Download figureDownload PowerPointFigure. Smoking-cessation interventions after stroke and transient ischemic attack. Proportions receiving smoking-cessation medication varied by event type (A). Results of multivariable model highlighting factors with associations with smoking-cessation medication provision (B).The rates and variability of in-hospital smoking-cessation medication provision suggest that optimizing the use of these interventions during hospitalization may enhance secondary prevention efforts.Article InformationSources of FundingThe Get With The Guidelines (GWTG)-Stroke program is provided by the American Heart Association/American Stroke Association. GWTG-Stroke is sponsored, in part, by Novartis, Novo Nordisk, AstraZeneca, Bayer, Tylenol and Alexion, AstraZeneca Rare Disease. Dr Parikh: research funding from NIH/NIA (K23 AG073524); New York State Empire Clinical Research Investigator Program; Florence Gould Endowment for Discovery in Stroke. This content is solely the responsibility of the authors and does not represent the official views of the NIH.Supplemental MaterialSupplemental Methods and ResultsTables S1–S3STROBE checklistDisclosures Dr Parikh: personal compensation for medicolegal consulting. Dr Schwamm: consultant (Genentech, TIMELESS NCT03785678; LifeImage; Massachusetts Department of Public Health); member, Data Safety Monitoring Boards (Penumbra, MIND NCT03342664; Diffusion Pharma, PHAST-TSC NCT03763929); National PI (Medtronic, Stroke AF NCT02700945); Site PI, StrokeNet Network NINDS (New England Regional Coordinating Center U24NS107243); CME lecturer (PRIME Education, Boehringer-Ingelheim); member, board of directors (American Heart Association). Dr Kamel: PI (ARCADIA, NINDS U01NS095869; in-kind study drug [BMS-Pfizer Alliance for Eliquis]; ancillary study support [Roche Diagnostics]); Deputy Editor (JAMA Neurology); member, clinical trial steering/executive committees (Medtronic, Janssen, Javelin Medical); member, end point adjudication committees (AstraZeneca, Novo Nordisk, Boehringer Ingelheim); ownership interest (TETMedical, Inc); consultant (American Medical Association). The other authors report no conflicts.FootnotesPresented in part at the International Stroke Conference, Dallas, TX, February 8–10, 2023.For Sources of Funding and Disclosures, see page e64.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.122.041532.Correspondence to: Neal S. Parikh, Department of Neurology, Weill Cornell Medicine, 420 E 70th St, LH408, New York, NY 10021. Email [email protected].cornell.eduReferences1. Parikh NS, Parasram M, White H, Merkler AE, Navi BB, Kamel H. Smoking cessation in stroke survivors in the United States: a nationwide analysis.Stroke. 2022; 53:1285–1291. doi: 10.1161/strokeaha.121.036941LinkGoogle Scholar2. US Preventive Services Task Force; Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW, Kubik M, et al.Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement.JAMA. 2021; 325:265–279. doi: 10.1001/jama.2020.25019CrossrefGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails March 2023Vol 54, Issue 3 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.041532PMID: 36727507 Originally publishedFebruary 2, 2023 Keywordsstrokesmoking cessationtransient ischemic attackcerebrovascular disordersPDF download Advertisement SubjectsCerebrovascular Disease/StrokeHealth ServicesRisk FactorsSecondary Prevention" @default.
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