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Smoking cessation: why is it a persistent problem in patients with peripheral artery disease?

09 November 2023
Volume 32 · Issue 20


Nurses play a key role in advising patients to quit smoking, especially those with long-term conditions including cardiovascular disease. Peripheral artery disease (PAD) is an increasingly prevalent condition, and is the third most common presentation of atherosclerotic disease after coronary heart disease and stroke. Smoking cessation is crucial for patients with PAD but can be very challenging. Stopping smoking reduces cardiovascular morbidity and mortality, and improves claudication symptoms in patients with PAD. Those who continue to smoke are at higher risk of disease progression, amputation, myocardial infarction and death, and have poorer therapeutic outcomes. Quitting smoking is difficult, and patients should be offered a combination of behavioural and drug therapy. Nurses can provide several interventions to help patients quit and prevent relapse. A pilot study in a large London hospital found that no smokers had been referred to smoking cessation services by their vascular clinician (although some had been referred by their GP), given brief cessation advice or told how smoking cessation was essential for vascular preservation. Many thought smoking cessation programmes would not work.

Peripheral artery disease (PAD) is a highly prevalent condition affecting 20% of the UK population aged over 60 years (Cea-Soriano et al, 2018; Morley et al, 2018). Atherosclerotic plaques builds up inside arteries, causing them to narrow and reduce blood flow to the limbs (Cea-Soriano et al, 2018; Morley et al, 2018) (Figure 1). More than 50% of patients with PAD are expected to have a major cardiovascular event (myocardial infarction or stroke) or amputation within 5 years of diagnosis (Cea-Soriano et al, 2018; Morley et al, 2018). A low clinical stage of PAD can progress from intermittent claudication to critical limb ischaemia in 21% of patients. PAD is the biggest cause of lower-limb amputation in the UK and 4-27% of people with claudication will need an amputation within 6 years of PAD onset (Sigvant et al, 2016). Ten years ago, the annual treatment cost of PAD in the UK was estimated to be between £774 679 and £1.3 million (National Institute for Health and Care Excellence (NICE), 2013); no more recent figures are available.

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