Awareness of smoking cessation amongst German vascular surgeons
First national survey
Abstract
Summary:Background: Smoking represents the well-known enemy of vascular well-being. Numerous previous studies emphasised the important role of smoking on the development and progression of atherosclerotic cardiovascular disease. The current study aimed to identify hurdles and barriers for an insufficient implementation of secondary prevention in the treatment of lower extremity peripheral arterial disease (PAD). Methods: All members of the German Society for Vascular Surgery and Vascular Medicine (DGG) with valid email addresses were invited to participate in an electronic survey on smoking. Results are descriptively presented. Results: Amongst 2716 invited participants, 327 (12%) submitted complete responses, thereof 33% women and 80% between 30 and 59 years old (87% board certified specialists). 83% were employed by hospitals (56% teaching hospital, 14% university, 13% non-academic) and 16% by outpatient facilities. 6% are active smokers (63% never) while a mean of five medical education activities on smoking cessation were completed during the past five years of practice. Only 27% of the institutions offered smoking cessation programs and 28% of the respondents were aware of local programs while a mean of 46% of their patients were deemed eligible for participation. 63% of the respondents deemed outpatient physicians primarily responsible for smoking cessation, followed by medical insurance (26%). Conclusions: The current nationwide survey of one scientific medical society involved in the care of patients with vascular disease revealed that smoking cessation, although being commonly accepted as important pillar of comprehensive holistic care, is not sufficiently implemented in everyday clinical practice.
References
1 Editor’s Choice – Prevalence of peripheral arterial disease, abdominal aortic aneurysm, and risk factors in the Hamburg City Health Study: a cross sectional analysis. Eur J Vasc Endovasc Surg. 2023;65:590–98.
2 Peripheral arterial disease (PAD) – A challenging manifestation of atherosclerosis. Prev Med. 2023;171:107489.
3 . Cyclooxygenase and atherosclerosis: a smoking area. Curr Pharm Des. 2010;16:2567–71.
4 Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases. J Am Coll Cardiol. 2019;74:498–507.
5 . Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389:1885–906.
6 Health effects of e-cigarettes and their use for smoking cessation from a vascular perspective. Vasa. 2023;52:81–85.
7 . Health care spending in the united states and other high-income countries. JAMA. 2018;319:1024–39.
8 . Smoking epidemic in Europe in the 21st century. Tob Control. 2021;30(5):523–529.
9 Long-term incidence of cancer after index treatment for symptomatic peripheral arterial disease – a health insurance claims data analysis. Vasa. 2020;49:493–99.
10 Cigarette smoking intensity informs outcomes after open revascularization for peripheral artery disease. J Vasc Surg. 2019;70:1973–83.e5.
11 Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease. J Vasc Surg. 2014;60:1565–71.
12 Association of smoking with postprocedural complications following open and endovascular interventions for intermittent claudication. JAMA Cardiol. 2022;7:45–54.
13 Editor’s Choice – 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:305–68.
14 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69:e71–e126.
15 ESVM guideline on peripheral arterial disease. Vasa. 2019;48:1–79.
16 Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019;58:S1 –S109 e33.
17 2018 ACC expert consensus decision pathway on tobacco cessation treatment: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2018;72:3332–65.
18 Canadian Cardiovascular Society 2022 guidelines for peripheral arterial disease. Can J Cardiol. 2022;38:560–87.
19 The prospective GermanVasc cohort study. Vasa. 2021;50:446–52.
20 , Limb related outcomes of endovascular vs. open surgical revascularisation in patients with peripheral arterial occlusive disease: a report from the prospective GermanVasc Cohort Study. Eur J Vasc Endovasc Surg. 2023;66:85–93.
21 Editor’s Choice – The GermanVasc Score: a pragmatic risk score predicts five year amputation free survival in patients with peripheral arterial occlusive disease. Eur J Vasc Endovasc Surg. 2021;61:248–56.
22 Amputation rates, mortality, and pre-operative comorbidities in patients revascularised for intermittent claudication or critical limb ischaemia: a population based study. Eur J Vasc Endovasc Surg. 2017;54:480–86.
23 . Raucherentwöhnung bei Patienten mit peripherer arterieller Verschlusskrankheit. Gefässchirurgie. 2023.
24 Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg. 2004;40:1158–65.
25 Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2021;4:CD010216.
26 Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses. Cochrane Database Syst Rev. 2023;9:CD015226.
27 . Elektrische Zigaretten – Stand der Forschung aus gefäßmedizinischer Sicht. Gefässchirurgie. 2023;28:140–44.
28 . [Not available]. Pneumologie. 2018;72:103–05.
29
Kröger CB . Tabakkonsum – ein wichtiges Feld der Prävention und Gesundheitsförderung. In:Tiemann M ,Mohokum M , (eds). Prävention und Gesundheitsförderung. Berlin, Heidelberg: Springer Berlin Heidelberg. 2020, 1–15.30 A prospective survey study on the education and awareness about walking exercise amongst inpatients with symptomatic peripheral arterial disease in Germany. Vasa. 2023;52(4):218–223.
31 Distribution of mobile health applications amongst patients with symptomatic peripheral arterial disease in germany: a cross-sectional survey study. J Clin Med. 2022;11:498.
32 How German vascular surgeons and angiologists judge walking exercise for patients with PAD. Vasa. 2023;52:224–29.
33 Editor's Choice – European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg. 2024;67:9–96.