Interestingly, the rates of abstinence were lower in subjects who used pharmacotherapy regardless of the intervention group (OR: 0.3; 95% CI: 0.2 to Seven first-line pharmacological treatments are available for smoking cessation therapy, including 5 nicotine- replacement therapies; the antidepressant bupropion; and varenicline, a partial agonist of the 4 2 subtype of the nicotinic acetylcholine receptor.659 661 The data supporting the use and timing of nicotine-replacement therapy after CABG are unclear. One study from a large general practice database reported no increased risk of MI, stroke, or death with nicotine-replacement therapy,662 whereas a retrospective case control study of critically ill patients reported a higher in-hospital mortality rate in those receiving nicotine replace- ment (20% versus 7%; P 0.0085). Despite adjusting for the severity of illness, nicotine-replacement therapy was an independent predictor of inhospital mortality (OR: 24.6; 95% CI: 3.6 to 167.6; P 0.0011).663 Similarly, in a cohort study of post-CABG patients, nicotine-replacement therapy was shown to be an independent predictor of in-hospital mortality after adjusting for baseline characteristics (OR: 6.06; 95% CI: 1.65 to 22.21).663,664 Additional studies are needed to deter- mine the safety of nicotine-replacement therapy in smokers undergoing CABG as well as the optimal time at which to begin such therapy postoperatively. 4.8. Emotional Dysfunction and Psychosocial Considerations: Recommendation Class IIa 1. Cognitive behavior therapy or collaborative care for patients with clinical depression after CABG can be beneficial to reduce objective measures of depres- sion.665 669 (Level of Evidence: B) The negative impact of emotional dysfunction on risk of morbidity and mortality after CABG is well recognized. 