A meta-analysis of randomized controlled trials evaluating the efficacy of smoking cessation interventions in people with peripheral artery disease

Objective: This review aimed to systematically pool evidence from randomized clinical trials on the efficacy of interventions in assisting smoking cessation in participants with peripheral artery disease (PAD). Methods: Publicly available databases were searched for randomized clinical trials testing the effect of interventional programs in achieving smoking cessation in participants with PAD who were current smokers. The primary outcome was smoking cessation at the end of follow-up. Meta-analyses were performed using random effect models and reported as risk ratios and 95% confidence intervals. Risk of bias and publication bias were assessed using a modified version of the Cochrane Collaboration's tool and funnel plots, respectively. Results: Six randomized clinical trials testing smoking cessation programs comprising physician advice, behavioral counselling from an expert delivered in-person or over the telephone, and the provision of nicotine replacement therapy and/or varenicline in 558 smokers with PAD were included. A meta-analysis suggested that, overall, these interventions did not significantly increase the chance of quitting smoking (risk ratio, 1.48; 95% confidence interval, 0.84-2.61), with low heterogeneity between studies (I-2 = 20%), which were robust in sensitivity analyses. Risk of bias was high, moderate, and low in one, three, and two studies respectively. A funnel plot suggested a low risk of publication bias. Conclusions: Overall, previously tested smoking cessation interventions have not been effective in achieving smoking cessation in people with PAD. Further research is needed to develop and test interventions that can effectively help current smokers with PAD to quit.