Smoking cessation efforts fall short for PAD patients
About 72 percent of active smokers with peripheral artery disease (PAD) continued to smoke a year after visiting a specialty vascular clinic for new or worsening claudication, according to a new study, despite more than three-quarters of them being offered advice or support to quit.
But the results of the study suggest the patients shouldn’t shoulder all the blame. Of the 75.7 percent of smokers who were given some sort of cessation intervention, only 15.6 percent received a referral to a formal counseling program and only 10.5 percent received pharmacologic treatment or nicotine replacement therapy. The rest were simply advised to stop smoking, with about 80 percent of cases lacking a documented reason for why the other interventions weren’t offered.
“Mandatory implementation of smoking cessation support provision as a quality metric for vascular specialty clinics and increased advocacy and outreach of professional vascular provider societies emphasizing repeated provision of cessation support at each visit or hospitalization by vascular disease providers is essential to achieve higher smoking cessation rates in this high‐risk population,” lead author Krishna K. Patel, MD, MSc, a cardiology fellow at the University of Missouri-Kansas City, Saint Luke’s Mid America Heart Institute, and colleagues wrote in the Journal of the American Heart Association.
“Furthermore, establishment of health systems’ infrastructure to facilitate easy referral and access to smoking cessation counselors and programs by vascular specialists and patients could help increase the use of these services by clinicians and patients.”
Patel and colleagues studied 1,272 patients who presented to 16 vascular specialty clinics across the U.S., the Netherlands and Australia from June 2011 to December 2016. All of the individuals in the study had new or worsening leg pain or cramping upon physical exertion.
About 202 million adults in the world are affected by PAD, the authors noted, and smoking is the most important modifiable risk factor for the disease.
“Patients with PAD who smoke have higher rates of disease progression, greater risk of complications secondary to PAD, poor post‐procedural outcomes, compromised functional status, and increased hospitalizations; all accounting for a higher patient and societal burden,” the researchers wrote. “Furthermore, active tobacco use in patients with PAD is strongly associated with a significant increase in cardiovascular events, including myocardial infarction and death, underscoring the urgent need for smoking cessation efforts in this population.”
Thirty-seven percent of study participants were active smokers when they first presented to their respective clinics. Patients’ chances of quitting were highest (21 percent) in the first three months after seeing the specialists, although 36 percent who managed to stopped smoking relapsed within one year and 72 percent of those who smoked at baseline were still active smokers a year later.
“The dynamic nature of peripheral artery disease patients’ smoking practices underscores the need for ongoing assessment of smoking, even among those who report that they had quit,” Patel et al. wrote. “Improved efforts to offer ongoing evidence‐based cessation support are needed.”
Patel and colleagues said studies have shown higher rates of smoking cessation in other atherosclerotic disease populations, including patients with coronary artery disease, previous myocardial infarction or elective percutaneous coronary intervention. They speculated this could be related to mandatory performance measures for those conditions or patients having increased motivation to stop smoking after experiencing a life-threatening event such as a heart attack.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.