title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA. Electronic address: dgaalema@uvm.edu.
authors.forename: Diann E
authors.initials: DE
authors.lastname: Gaalema
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Cutler
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, USA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Ades
mesh_terms: D003327:Coronary Disease / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010352:Patient Dropouts; D011183:Postoperative Complications / Q000517:prevention & control; D012017:Referral and Consultation; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D016540:Smoking Cessation; D015996:Survival Rate
keywords: Adherence; Attendance; Cardiac rehabilitation; Dropout; Enrollment; Participation; Referral; Smoking; Smoking cessation