Abstract 329: Effect of Psychological Distress on Cardiovascular Event Rates One Year Following Cardiac Rehabilitation

Abstract

Rationale: Psychological (psych) distress is a putative risk factor for coronary artery disease (CAD) and may affect compliance with lifestyle & treatment. We sought to determine the impact of psych distress in cardiac rehab (CR) patients (pts) on cardiovascular event rates (CVE) including PCI/CABG, coronary angiogram, acute coronary syndrome (ACS). Methods: Psych profile of 440 CAD pts was assessed on entry to CR using Symptom Check List-90 (SCL-90). Questionnaire screened for depression (dep), anxiety (anx), hostility, and a global severity index (GSI). Mean SCL-90 T-score for each parameter in the adult population is 50 with a standard deviation of 10. SCL-90 score ≥60 = 84th percentile, SCL≥63 = 90th percentile, SCL score ≥70 is the 98th percentile. Complete data on repeat admissions and subsequent non-elective and elective CV procedures performed in the one-year following enrollment to CR was available on 410 pts. Results: Of the 440 pts 28.4% were female, 75.7% married and 89% Caucasian; 25.5% were hypertensive, 20.5% diabetic and 47% had a BMI>30. Mean age was 61.5+10.7. Clinical indication for CR: 56.4% PCI/CABG, 8.4% stable angina (SA) and 35.2% ACS. There was a high prevalence of dep, anx, and overall psych distress as measured by the GSI (Table1.) SA pts had significantly higher prevalence of anx (p=0.018) and hostility (p=0.009) compared to PCI/CABG and ACS. There was no difference in SCL-90 scores by gender, age, education, body mass index (BMI) or diabetes. 89 CVE required hospital admission; 62 (15.1%) pts once and 27(6.5%) two or more times. Reasons for the 89 readmissions included myocardial infarction (7.9%), SA (11.2%), unstable angina (50.6%) and other non-cardiac (30.3%). 62 procedures were performed, which included 6(10%) CABG, 21(34%) PCI, 20(32%) heart catheterizations, and 15(24%) other procedures. Forty percent of procedures performed were elective. Odds of readmission at one year was 3.14 greater in pts with dep score ≥70 (p=0.003) and 2.95 times greater in pts with Anx score ≥70 (p=0.037). Pts with dep score ≥70 were 3.4 times more likely to get a non-elective procedure (p<0.001), while the likelihood of a non-elective procedure in a patient with anx score ≥70 was not statistically significant (p=0.59) (Table 2.) 32 (7.8%) of pts had both dep and anx scores ≥ 63 and these pts were significantly more likely to be re-admitted OR 3.14, (p=0.003) and more likely to have multiple admissions OR 3.9 (p=0.007). Conclusions: Psych distress in CR pts has a significant impact on outcomes. Consideration should be given to routine psych profiling at entry to CR and appropriate treatment for these pts.