Abstract
Introduction: Patients with mental health conditions have higher rates of ischemic heart disease but have been less likely than those without mental health conditions to participate in traditional (center-based) cardiac rehabilitation programs. We sought to examine the association of mental health conditions with rates of participation in (and completion of) home-based cardiac rehabilitation (HBCR). Methods: The Veterans Health Administration is developing new HBCR programs to improve access for patients with cardiovascular disease who are unable to attend traditional (center-based) programs. Among 323 hospitalized patients who were eligible and referred to cardiac rehabilitation at the San Francisco VA between 8/1/15 and 9/30/16, we evaluated the association of depression and/or PTSD (defined based on manual review of medical records) with participation in and completion of HBCR. Logistic regression models were used to adjust for patient demographics, primary indication for CR and comorbid conditions. Results: Of the 323 eligible patients referred to HBCR, 127 (39%) suffered from depression and/or PTSD. Participation rates were 41% (52/127) in patients with vs. 32% (62/196) in patients without depression or PTSD (p=0.09). Among the 114 patients who agreed to participate in HBCR, 52 (46%) suffered from depression and/or PTSD. Rates of completing 9 or more sessions were 67% (35/52) in patients with vs. 44% (27/62) in patients without depression or PTSD (p=0.01). After multivariable adjustment, patients with depression and/or PTSD had a 3-fold greater odds of completing HBCR than those without depression or PTSD (OR 2.85, 95% CI 1.14- 7.17; p=0.02). Conclusions: Among patients referred to cardiac rehabilitation, those with a history of depression and/or PTSD were equally likely to participate and significantly more likely to complete HBCR than those without depression and/or PTSD. These findings suggest that patients with mental health conditions may be especially likely to benefit from HBCR.
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