October 03, 2018
2 min read

Smoking cessation strategies underutilized in PAD

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More than one-third of patients with claudication who consulted a provider about peripheral artery disease were active smokers, and few of those patients received evidence-based cessation interventions, according to a study published in the Journal of the American Heart Association.

“Smoking is the single most important risk factor for development and progression of peripheral artery disease,” Krishna K. Patel, MD, MSc, cardiology fellow at University of Missouri-Kansas City, said in a press release. “More importantly, it is modifiable. Smoking cessation is the cornerstone for managing patients with this disease.”

PORTRAIT registry

Researchers analyzed data from 1,272 patients from the PORTRAIT registry with symptomatic PAD who presented to clinics from June 2011 to December 2015. Patients who presented to a PAD specialist had new-onset or a recent exacerbation of exertional leg symptoms and either an abnormal resting ankle-brachial index or a significant decrease in postexercise ankle pressure.

During the first visit to a specialty PAD provider, claudication symptoms were evaluated and information was obtained, including health status, patient demographics, socioeconomic/CV lifestyle factors and psychosocial characteristics. Medical records were reviewed to abstract information regarding medical history, symptoms, PAD diagnostic information, comorbidities and smoking cessation intervention performance measures. Telephone interviews were conducted at 3, 6 and 12 months to collect information on smoking status, health status and psychosocial and lifestyle factors.

In-person interviews were also performed at baseline to assess smoking status. Patients were then categorized as never smokers (n = 138; mean age, 74 years; 41% men), former smokers (n = 660; mean age, 70 years; 67% men) and current smokers (n = 474; mean age, 63 years; 62% men). Never smokers were defined as those who smoked fewer than 100 cigarettes in total or none at all; former smokers were patients who either stopped smoking more than 1 year ago or between 1 month and 1 year ago, and those categorized as current smokers had smoked at least one puff in the past 30 days.

Among patients who were active smokers, 15.6% were referred to a smoking cessation counseling program and 10.5% received nicotine replacement therapy or pharmacological treatment.

Rates of smoking cessation

The likelihood of patients to quit smoking peaked at 3 months (21%; 95% CI, 18-26), which decreased (P < .001) to 11% at 6 months (95% CI, 8-15) and 12% at 12 months (95% CI, 8-16).

Among patients who initially quit smoking, 36% had a relapse. At 12 months, 72% of patients who were active smokers at baseline continued to smoke (95% CI, 67-76).

“The dynamic nature of these patients’ smoking practices also underscores the need for ongoing assessment of smoking, even among those who report that they have quit, and consistent offering of evidence-based cessation support,” Patel and colleagues wrote. “Future research should focus on identifying optimal strategies for implementing consistent cessation support.” – by Darlene Dobkowski

Disclosures: The study was partially funded by an unrestricted grant from W.L. Gore and Associates. Patel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.