Smoking often neglected in peripheral artery disease

Patients with claudication consulting a peripheral arterial disease provider are often active smokers, rarely receive evidence-based cessation interventions, and frequently relapse if they do quit, according to a report published.

More than one-third of patients with claudication consulting PAD specialists are active smokers, as seen in a data analysis of an international registry.

The authors assessed 1,272 patients with PAD and new or worsening claudication who were enrolled at 16 vascular specialty clinics from 2011 to 2015 in the PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry.

In-person interviews obtained smoking status from the patients and information on cessation interventions at baseline and at 3, 6, and 12 months. At baseline, 474 (37%) patients were active, 660 (52%) were former, and 138 (11%) were never smokers.

Among active smokers, only 16% were referred to cessation counseling, and only 11% were prescribed pharmacologic treatment.

At 3 months, the probability of quitting smoking was 21%. Those who kept smoking had a probability of quitting during the next 9 months that varied between 11% and 12% (P less than .001).

The probability of relapse was high, with more than one-third of initial quitters (36%) resuming smoking, and at 12 months; 72% of all original smokers continued to smoke, according to the authors.

The high level of initial smoking and the failed efforts at attempting cessation are clinically important because cigarette smoking is the most important and modifiable risk factor for PAD, and patients with PAD who smoke have higher rates of disease progression.

Few patients receive formal cessation interventions. 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. Future research should focus on identifying optimal strategies for implementing consistent cessation support, the researchers concluded.