Effectiveness of a Smoking Cessation Program for Peripheral Artery Disease Patients: A Randomized Controlled Trial

Abstract

Conclusions: Many long-term smokers with peripheral artery disease (PAD) are willing to engage in an intensive smoking cessation program. A smoking cessation program with intensive intervention is more effective than minimal care. Summary: Only one randomized trial has evaluated the effectiveness of smoking cessation programs. This trial (Gavin K, et al, Int J Nurs Stud 2001;38:91-105) evaluated the effectiveness of a nurse-conducted smoking cessation education program using nicotine gum. There was a difference between the intervention and control group's self-reported number of cigarettes smoked. However, biomarkers of tobacco use (urinary cotinine and expired carbon monoxide) provided conflicting results with the self-reported number of cigarettes smoked. Given that cigarette smoking is the most important risk factor for development of progression of PAD, the current study was designed to test the effectiveness of an intensive smoking cessation program in patients with PAD. The authors first sought to determine whether PAD patients were willing to enroll in such a program. The second objective was to examine the effectiveness of the program. Participants, who were recruited as outpatients, were identified as having lower extremity PAD from medical records and were also identified as cigarette smokers. They were randomly assigned to minimal intervention or an intensive tailored PAD-specific counseling intervention. Surveys were completed at baseline and at 3 and 6 months. Reported 7-day prevalent smoking abstinence was confirmed by carbon monoxide or cotinine levels. Of 687 outpatients identified as probable smokers with lower extremity PAD, 232 met eligibility requirements for this study and 124 (53% of those eligible) enrolled in the study. Participants were receptive to counseling. They received a median of 8.5 counseling sessions (range, 0-18). Those participants who had been assigned to the intensive intervention group were more likely to have confirmed abstinence from cigarette smoking at the 6-month follow-up: 21.3% in the intensive group vs 6.8% in the minimal intervention group (χ2 = 5.21; P = .023). Comment: Many patients with PAD who are smokers are interested in quitting and are receptive to a formal smoking cessation program. Those who chose to participate in the study almost universally indicated an understanding of the health risks of smoking. There was a high desire to quit cigarette smoking, as evidenced by the high level of engagement in the counseling sessions by those assigned to intensive intervention. The participants in this study were highly motivated to quit, but only about one-fifth of those in the intensive intervention group were able to quit. The study indicates the importance of more intensive intervention in achieving abstinence from cigarette smoking. Perhaps most importantly, it points out the best we have to offer to achieve smoking cessation is still woefully inadequate, even for motivated patients.