Depression, Anxiety Can Derail Cardiac Rehabilitation

A new study is shedding light on the mental health of patients in cardiac rehabilitation and how depression or anxiety can play a role in them continuing rehab or properly adhering to their medications.

Published on World Mental Health Day, results of the study revealed nearly 1 in 5 cardiac rehabilitation patients suffered from depression and highlight the need for monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation to assist with improving adherence.

In an attempt to evaluate and assess the prevalence and impact of depression and anxiety on patients in cardiac rehabilitation, investigators from the University of Technology Sydney designed a retrospective cohort study of patients who entered rehabilitation programs from 2006 to 2016. Investigators obtained data on a cohort of 5908 patients from 2 Sydney metropolitan teaching hospitals.

Investigators were able to obtain information on variables including demographics, diagnoses, cardiovascular risk factors, medication use, and participation rates—as well as, Medical Outcomes Study Short Form-36 and Depression Anxiety Stress Scales(DASS-21) subscale scores.

Upon review, 4784 of the 5908 had completed the DASS-21 questionnaire on entry into a rehabilitation program. Based off the questionnaires, investigators concluded symptoms of moderate to extremely severe depression were prevalent in 867 (18%) adults. Additionally, 1333(28%) reported having moderate to extremely severe anxiety, while 637 (13%) reported having symptoms of moderate to extremely severe stress on entry.

Among those with at least moderate depression, anxiety, or stress symptoms, a significantly greater proportion were male (79%), married, engaged, or in a de-facto relationship(74%), or employed(48%). Investigators noted this group had a mean age of 60 years. Investigators observed heart disease risk factors were increasingly prevalent among adults with sedentary lifestyle(58%), hypertension(62%), and hypercholesterolemia(11%).

Analyses revealed adults with moderate depression(24% versus 13%), anxiety(32% versus 23%), or stress symptoms(18% versus 10%) were significantly less likely to adhere to cardiac rehabilitation compared to those without such symptoms. Anxiety (OR 4.395, 95% CI 3.363—5.744, P<0.001) and stress(OR 4.527, 95% CI 3.315—6.181, P<0.001) were the strongest predictors of depression observed during the study period.

Similarly, the presence of depression(OR 3.167, 95% CI 2.411—4.161) and stress(OR 5.577, 95% CI 4.006–7.765, P<0.001) increased the risk of anxiety on entry more than the risk incurred by socio-demographic factors, cardiovascular risk factors, diagnoses, and quality of life.

In a release from the European Society of Cardiology, lead investigator Angela Rao, PhDc, of the University of Technology Sydney, said the study highlights the need for monitoring of these symptoms as they have a profound impact on outcomes for patients undergoing rehabilitation.

“Patients who attend cardiac rehabilitation programmes do better than those who don’t,” Rao said. “If you think you may need extra support or are hesitant to seek help, it's advisable to attend the initial assessment as a first step. There may be options you feel more comfortable with, such as completing a programme at home.”

This study, “The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study,” was published in the European Journal of Preventive Cardiology.