P eripheral A rterial D isease

PeripheralArterial

Disease

Patients’ awareness of smoking as a risk factor

Class 5, 1st year2009/2010

Adviser: Sérgio Sampaio

McDermott MM. Cleve Clin J Med. 2006.Remes L, et al. 2008.Gutacker N, et al. 2009.Zanati SG, et al. Clinics. 2009.

INTRODUCTION: BACKGROUND

Narrowing and hardening of arteries

Decreased blood flow

PAD

Difficulty in walking, rest pain, ulceration, lower extremity amputation,

death.

Risk Factors

Hypertension Hypercholesterolemia

Diabetes Smoking

Selvin E. et al. Circulation. 2004.

Criqui MH. Vasc Med. 2001.

Awareness of smoking as a risk factor

Don't know44%

Know56%

Hirsch AT et al. Circulation. 2007.

JustificationWe decided to evaluate the awareness of

smoking as a risk factor because:

People, most of the times, cannot control the expression of diabetes, but it is their choice to smoke or not to;

There is a low community consciousness of this risk factor.

Justification

It will be important to know the awareness of the

Portuguese PAD patients to this modifying risk

factor, because that way it will be easier to define

strategies to improve the communication and to try

to make people change their smoking habits.

Research Question

How aware are patients with PAD regarding smoking as a major risk factor?

Aims1. Quantify how frequently patients with PAD know

about smoking as a cause and a prognostic of their condition.

2. Determine when and by whom were they warned about this fact.

3. Find out whether people in this state have changed or not their smoking habits due to the provided information.

• (If they have) Find out if the severity of the disease altered.

Participants and MethodsOur target population are

Portuguese patients suffering from PAD who are admitted in a hospital.

Our inclusion criterion is the patients with PAD being admitted in the Vascular Surgery Department of Hospital de S. João.

Our exclusion criteria are:

Patients unable to consciously communicate;

Patients who do not agree to get involved in this study.

Participants and Methods

Study designAnalytic retrospective cohort:

patients who were informed of tobacco as a risk factor with patients who were not (cohort)

events that happened in the past (retrospective):try to establish the relations among them (analytic)

Present

Past FutureInformed Not Informed

Data collecting methods

Questionnaires were done to patients suffering from PAD, who were admitted in the Vascular Surgery Department of Hospital de São João.

Sample

68%(28)

32%(13)

PatientsIncluded Excluded

Exclusion criterion:Patients unable

to consciously communicate.

Variables description

Personal data of PAD patientsDiabetes;Hypertension;Hypercholesterolemia;State of the disease at the time of the diagnosis,

according to Lerishe-Fontaine classification; Current state of the disease;Date of PAD diagnosis;Smoking habits;

Variables description

PAD risk factors awarenessAwareness of:

Diabetes;Hypercholesterolemia;Hypertension;Smoking;

Knowledge sources;• If the information was given by a doctor, another variable we

decided to put was the specialty of the doctor . Time of risk factors awareness.

Variables description

Behaviour changes after awareness of PAD risk factors:

Change of smoking habits;Way of change;Number of attempts, if the interviewed patient

tried to quit smoking without success.

Statistical analysis/Expected results

Scholar degree and the awareness of the risk factors;

Time of risk factors awareness and date of PAD

diagnosis;

Change of smoking habits (type of change) and state

of the disease after that behaviour change (evolution

of the disease).

Sample description

Female Male

21.40%

78.60%

Gender

Sample description

Mean=64,71

Ensino

prim

ário

2.º ci

clo

3.º ci

clo

Ensino

secu

ndári

o

Ensino

supe

rior

76.9%

3.8%15.4%

3.8% 0.0%

Escolaridade

Sample description

Sample description

Non smoker43%

Smoker11%

Former smoker

46%

Smoking habits

Results

Yes75%

No21%

Don't know4%

Awareness of smoking as a risk factor

Know44%Don't

know56%

Hirsch AT et al. Circulation. 2007.

Results

1-4 years (20) 5-6 years (1) 7-9 years (4) 10-12 years (1)

50%

100%

75%

100%

Awareness of diabetes

Results

1-4 years 5-6 years 7-9 years 10-12 years

50%

100%

75%

100%

Awareness of hypertension

Results

1-4 years 5-6 years 7-9 years 10-12 years

45%

100%

50%

100%

Awareness of hypercholesterolemia

Results

1-4 years 5-6 years 7-9 years 10-12 years

85%100%

50%

0%

Awareness of smoking

Results

54%31%

15%

Time of risk factors awareness

Before PAD diagnosis

At the moment of PAD diagnosis

After PAD diagnosis

Results

15%(2)

62%(8)

23%(3)

State of the disease after smoking habits change

Did not evolute

Got better

Got worse

Results

12%4%

8%

77%

Knowledge sources

TVNewspapersFriends/familyDoctor

ObservationsAfter 20 days, we have a small sample (N=28).

Therefore, the results we achieved were not statiscally significant and there is no variability among some data.

We were not able to relate some important variables, such as Change of smoking habits (type of change) and State of the disease after that behaviour change (evolution of the disease).