Intervention program increased smoking cessation among patients with PAD

**Hennrikus D. J Am Coll Cardiol. 2010;56:2105-2112. Jackson E. J Am Coll Cardiol. 2010;56:2113-2114.**

Issue: January 2011

Patients with peripheral arterial disease were found to be receptive to smoking cessation programs and experienced a significantly higher rate of cessation as a result of taking the program at 3 and 6 months vs. those in a minimal intervention program.

“Many long-term smokers with PAD are willing to initiate a serious quit attempt and to engage in an intensive smoking cessation program. Such engagement with an intensive PAD-specific intervention is associated with a significant increase in smoking abstinence,” trial investigators wrote.

The investigators enrolled outpatients with lower extremity PAD who were also cigarette smokers. They randomly assigned patients to either an intensive tailored PAD-specific counseling (n=64) or a minimal intervention (n=60) that included advice to quit smoking and a list of smoking cessation programs in their community. Surveys were completed at baseline, 3 and 6 months.

Overall, patients proved receptive to counselor contact, and the median number of sessions was 8.5. At 3 months, self-report intent-to-treat analysis indicated 21.3% abstinent rate in the intensive arm vs. 6.8% in the minimal arm (P=.023). Similarly, 6-month self-report abstinent rates favored the intensive arm (31.2% vs. 10.2%; P=.005), which remained consistent when investigators biochemically verified intent-to-treat analysis (intensive, 21.3% vs. minimal, 6.8%; P=.023).

“These results indicate the importance of incorporating smoking cessation treatment into the medical management of PAD,” the investigators concluded. “Given high levels of addiction and significant barriers to quitting in many PAD patients, treatment should include tobacco dependence management that is rigorous and long-term. Future investigation of a larger sample with longer follow-up should be conducted to evaluate the impact of this intervention on limb symptoms and systemic ischemic event rates.”

In an accompanying editorial, Elizabeth A. Jackson, MD, and Kim A. Eagle, MD, of the division of cardiovascular medicine, University of Michigan Health System, Ann Arbor, said although the findings are clinically relevant, there remain some challenges of implementing the intervention.

“For many practitioners and patients with PAD, the cost in time and resources to provide and receive intensive counseling sessions is prohibitive,” they said. “In addition, currently many smoking cessation products are not covered by insurance; thus, smokers are often reluctant to pay out-of-pocket for such products.”

As a way to help curb the logistical and financial difficulties, as well as supplement face-to-face counseling, they recommended exploring other alternatives, such as social media and online programs.

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