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Patient Characteristics Associated with Active Smoking Upon Presentation with Claudication Symptoms to Specialty Clinics: Insights from the PORTRAIT Registry

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Patient Characteristics Associated with Active Smoking Upon Presentation with Claudication Symptoms to Specialty Clinics: Insights from the PORTRAIT Registry Robert Corn MD1 ; Kim Smolderen PhD1,2; Kim Dyer RN1 ; Kensey Gosch MS2 ; Nancy Stone MEd2 ; John Spertus MD MPH1,2; Mark Friedell MD1 1 University of Missouri-Kansas City School of Medicine and 2 Saint Luke’s Mid America Heart Institute, Kansas City, MO


In patients with claudication, smoking is an important factor in treatment selection, since it is a potent risk factor for disease progression and for graft or endovascular treatment failure. Therefore, active smoking is an important consideration in PAD treatment selection.

Given these selection biases, observational, comparative e ectiveness studies of claudication treatment need to adjust for other potential patient characteristics associated with smoking.

It is unknown what patient pro les are associated with smoking in patients facing a treatment decision for their claudication symptom.

Understanding what patient factors are associated with active smoking, would help to understand how to best support patients in addressing this risk in light of the PAD treatment.


We addressed the aims in the international, multi-center Patient- centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) study.

1,142 patients were referred to 16 PAD specialty clinics for new or exacerbation of claudication symptoms and enrolled between 2/2/2011 and 9/25/2015.

Smoking status was veri ed through patient interviews before initial treatment.


Demographic, socio-economic, clinical, and psychosocial information was obtained from patient interviews and medical record abstraction.

The patient population was described by smoking status (non-smoking, former smoking, active smoking) and the F-values associated with the ANOVA tests were reported.


Upon presentation, 38% of patients were actively smoking and 52% were former smokers. The top 20 characteristics associated with smoking status in claudication patients are listed in the Table 1.

As compared with non-smoking patients, patients that smoked were younger, had an active working status, less cardiovascular risk factors, and presented with higher levels of depressive and anxiety symptoms.


Patients facing a treatment decision for claudication symptom relief that are active smokers have a distinct pro le.

A better understanding of the patient pro le associated with smoking in PAD will help prioritize e orts to support patients in addressing this risk factor.

It will also enable us to account for these vast individual di erences with comparative e ectiveness research examining the interaction between PAD treatment, smoking, and subsequent outcomes.


Further steps that will be addressed using the unique PORTRAIT study data include examining the site and PAD provider variations in care provided to patients in managing the risk factor of smoking.

We also plan to evaluate smoking as a predictor of PAD treatment allocation.


Research reported in this poster was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CE-1304-6677).

The statements in this poster are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors or Methodology Committee.

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