Main Article Content

David Dong Qi Zhang
Mark J. Eisenberg
Sonia M. Grandi
Lawrence Joseph
Jennifer O'Laughlin
Gilles Paradis
Pedro Lozano
Kristian B. Filion


Smoking cessation, myocardial infarction, bupropion, health - related quality of life



The use of bupropion, a smoking cessation aid, has been associated with improved health-related quality of life (HRQOL) in the general population of smokers; but, its effect on HRQOL in post-myocardial infarction (MI) patients remains unknown.


To examine the effect of bupropion on HRQOL in post- MI patients who are attempting to quit smoking.


To accomplish this objective, we used data from a randomized, double-blind, placebo-controlled trial in 392 hospitalized post - MI patients. Treatment duration was 9 weeks, and follow - up was 12 months. HRQOL was assessed via the EuroQol - 5D (EQ - 5D) questionnaire, which includes 5 dimensions (mobility, self - care, daily activities, pain/discomfort, and anxiety/depression). Analyses were restricted to patients (n=225) who completed the EQ - 5D at baseline, 6 months, and 12 months.


Patients randomized to bupropion (n=109) and those randomized to placebo (n=116) experienced similar improvements in HRQOL during follow - up (difference in change in EQ - 5D index from baseline to 6 months = 0.02, 95% confidence interval [CI] = - 0.04, 0.08; from baseline to 12 months = 0.02, 95% CI = - 0.04, 0.08). No between-group differences were observed in any of the 5 dimensions. Similar improvements in HRQOL were observed between patients who remained abstinent and those who relapsed. Lower baseline HRQOL, defined as having a HRQOL that was less than the median value, was associated with decreased smoking abstinence at 12 months follow - up (odds ratio [OR] =0.39, 95% CI = 0.22, 0.68).


Bupropion does not improve HRQOL among patients attempting to quit smoking post - MI.

Abstract 134 | PDF Downloads 50


1. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999 March 4;340(9):685 - 91.
2. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA 1999 January 6;281(1):72 - 6.
3. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993 April 15;118(8):622 - 9.
4. Dunner DL, Kwong WJ, Houser TL, et al. Improved health - related quality of life and reduced productivity loss after treatment with bupropions ustained release: A study in patients with major depression. Prim Care Companion J Clin Psychiatry 2001 February;3(1):10 - 6.
5. Fortner MR, Brown K, Varia IM, et al. Effect of Bupropion SR on the quality of life of elderly depressed patients with comorbid medical disorders. Prim Care Companion J Clin Psychiatry 1999 December;1(6):174 - 9.
6. Hewett K, Chrzanowski W, Jokinen R, et al. Double-blind, placebo-controlled evaluation of extended-release bupropion in elderly patients with major depressive disorder. J Psychopharmacol 2010 April;24(4):521 - 9.
7. Cullum JL, Wojciechowski AE, Pelletier G, Simpson JS. Bupropion sustained release treatment reduces fatigue in cancer patients. Can J Psychiatry 2004 February;49(2):139 - 44.
8. Moss EL, Simpson JS, Pelletier G, Forsyth P. An open-label study of the effects of bupropion SR on fatigue, depression and quality of life of mixed - site cancer patients and their partners. Psychooncology 2006 March;15(3):259 - 67.
9. Hays JT, Croghan IT, Baker CL, Cappelleri JC, Bushmakin AG. Changes in health-related quality of life with smoking cessation treatment. Eur J Public Health 2012 April;22(2):224 - 9.
10. Eisenberg MJ, Grandi SM, Gervais A, et al. Bupropion for smoking cessation in patients hospitalized with acute myocardial infarction: a randomized, placebo-controlled trial. J Am Coll Cardiol 2013 February 5;61 (5):524 - 32.
11. EuroQol -- A new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990 December;16(3):199 - 208.
12. Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ - 5D health states: development and testing of the D1 valuation model. Med Care 2005 March;43(3):203 - 20.
13. Schweikert B, Hahmann H, Leidl R. Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart 2006 January;92(1):62 - 7.
14. Ellis JJ, Eagle KA, Kline - Rogers EM, Erickson SR. Validation of the EQ - 5D in patients with a history of acute coronary syndrome. Curr Med Res Opin 2005 August;21(8):1209 - 16.
15. Kahyaoglu SH, Unsar S. Is EQ - 5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu Kardiyol Derg 2011 March;11(2):156 - 62.
16. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
17. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991 September;86(9):1119 - 27.
18. Rieckmann N, Kronish IM, Shapiro PA, Whang W, Davidson KW. Serotonin reuptake inhibitor use, depression, and long - term outcomes after an acute coronary syndrome: a prospective cohort study. JAMA Intern Med 2013 June 24;173(12):1150 - 1.
19. Mulder I, Tijhuis M, Smit HA, Kromhout D. Smoking cessation and quality of life: the effect of amount of smoking and time since quitting. Prev Med 2001 December;33(6):653 - 60.
20. McClave AK, Dube SR, Strine TW, et al. Associations between smoking cessation and anxiety and depression among U.S. adults. Addict Behav 2009 June;34(6 - 7):491 - 7.
21. Wilson D, Parsons J, Wakefield M. The health-related quality - of - life of never smokers, ex-smokers, and light, moderate, and heavy smokers. Prev Med 1999 September;29(3):139 - 44.
22. Strine TW, Okoro CA, Chapman DP, et al. Health-related quality of life and health risk behaviors among smokers. Am J Prev Med 2005 February;28(2):182 - 7.
23. Sarna L, Bialous SA, Cooley ME, Jun HJ, Feskanich D. Impact of smoking and smoking cessation on health-related quality of life in women in the Nurses' Health Study. Qual Life Res 2008 December;17(10):1217 - 27.
24. Tillmann M, Silcock J. A comparison of smokers' and ex-smokers' health-related quality of life. J Public Health Med 1997 September;19(3):268 - 73.
25. Wiggers LC, Oort FJ, Peters RJ, Legemate DA, de Haes HC, Smets EM. Smoking cessation may not improve quality of life in atherosclerotic patients. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco 2006 August;8(4):581 - 9.
26. Quist - Paulsen P, Bakke PS, Gallefoss F. Does smoking cessation improve quality of life in patients with coronary heart disease? Scand Cardiovasc J 2006 February;40(1):11 - 6.
27. Taira DA, Seto TB, Ho KK, et al. Impact of smoking on health-related quality of life after percutaneous coronary revascularization. Circulation 2000 September 19;102(12):1369 - 74.
28. Rumsfeld JS, Ho PM, Magid DJ, et al. Predictors of health-related quality of life after coronary artery bypass surgery. Ann Thorac Surg 2004 May;77(5):1508 - 13.

Most read articles by the same author(s)