Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence

Abstract

Objective Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence. Methods A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes. Results Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout. Conclusion Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

“…44,45 If the appropriate barriers within these various groups are identified CR staff can determine what interventions may be most useful, whether it is more education for the patient on the benefits of CR, a more intensive smoking cessation program, being open outside of normal working hours one day a week, or offering incentives for program completion. 17,46 Smoking cessation interventions should be a particularly high priority given the strong associations between current smoking and both high morbidity and mortality combined with strong associations with poor CR attendance…”

“…13-16,8 Effects of smoking have been reviewed, with current smoking being a powerful predictor of fewer sessions completed. 17 Lower-socioecomonic status (SES), measured by income, education, or having subsidized insurance (e.g. Medicaid), may also predict fewer sessions completed.…”

Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample

“…While not explicitly examined in this study, smokers with these profiles are more likely to be nicotine dependent and are at increased risk for adverse health impacts of smoking (Higgins and Chilcoat, 2009; Hiscock et al, 2012). The lower educational attainment levels and higher rates of alcohol and drug use disorders represented in those nodes also make it likely that other medical co-morbidities will be present further increasing vulnerability to the adverse health impacts of smoking (Cutler and Lleras-Muney, 2010; Gaalema et al, 2015; Hser et al, 2001; Niaura et al, 2012; Rowa-Dewar et al, 2015; Schroeder, 2007). These are patterns that contribute directly to the unsettling problem of health disparities (Higgins, 2014; Schroeder, 2007).…”

Editorial: 2nd Special Issue on behavior change, health, and health disparities

“…Continuing on the theme of co-morbid conditions, Gaalema et al (2015–in this issue) report results of a systematic literature review that thoroughly documents how cigarette smoking is associated with negative outcomes across multiple phases of the cardiac rehabilitation process. They underscore the need for renewed attention to promoting smoking cessation following treatment for coronary events including within the cardiac rehabilitation model.…”