Underutilization of evidence-based smoking cessation support strategies despite high smoking addiction burden in peripheral artery disease specialty care: Insights from the international PORTRAIT registry

Krishna K. Patel, Philip G. Jones, Edward F. Ellerbeck, Donna M. Buchanan, Paul S. Chan, Christina M. Pacheco, Gregory (Greg) Moneta, John A. Spertus, Kim G. Smolderen

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    Abstract

    Background-—Smoking is the most important risk factor for peripheral artery disease (PAD). Smoking cessation is key in PAD management. We aimed to examine smoking rates and smoking cessation interventions offered to patients with PAD consulting a vascular specialty clinic; and assess changes in smoking behavior over the year following initial visit. Methods and Results-—A total of 1272 patients with PAD and new or worsening claudication were enrolled at 16 vascular specialty clinics (2011–2015, PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry). Interviews collected smoking status and cessation interventions at baseline, 3, 6, and 12 months. Among smokers, transition state models analyzed smoking transitions at each time point and identified factors associated with quitting and relapse. On presentation, 474 (37.3%) patients were active, 660 (51.9%) former, and 138 (10.8%) never smokers. Among active smokers, only 16% were referred to cessation counseling and 11% were prescribed pharmacologic treatment. At 3 months, the probability of quitting smoking was 21%; among those continuing to smoke at 3 months, the probability of quitting during the next 9 months varied between 11% and 12% (P<0.001). The probability of relapse among initial quitters was 36%. At 12 months, 72% of all smokers continued to smoke. Conclusions-—More than one third of patients with claudication consulting a PAD provider are active smokers and few received evidence-based cessation interventions. Patients appear to be most likely to quit early in their treatment course, but many quickly relapse and 72% of all patients smoking at baseline are still smoking at 12 months. Better strategies are needed to provide continuous cessation support.

    Original languageEnglish (US)
    Article numbere010076
    JournalJournal of the American Heart Association
    Volume7
    Issue number20
    DOIs
    StatePublished - Oct 1 2018

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    Keywords

    • Peripheral arterial disease
    • Smoking

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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