Abstract
BackgroundPatients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR.MethodsAnalysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population.ResultsThe analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement.ConclusionThe study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.
Highlights
The association of depression with increased mortality is widely demonstrated in patients with cardiovascular disease (CVD) in a previous meta-analysis[1 2] as well as its association with poor cardiac prognosis
What does this study add? ►► The current study is the first to examine the patient characteristics that determine the change in depressive symptoms following cardiac rehabilitation (CR), in patients with new-o nset post-cardiac event depressive symptoms. How might this impact on clinical practice? ►► This paper shows that patients with new-o nset depressive symptoms are less likely to improve their depression levels following CR when they have such comorbidities and patient characteristics at baseline: comorbidities of angina, diabetes, stroke, emphysema, chronic back problems, and higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single according to multivariate analysis results
A recent National Audit of Cardiac Rehabilitation (NACR)–based study has contributed to this literature and found that baseline characteristics of patients with history of depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity and male gender were determinants of their depression levels following CR.[17]
Summary
The association of depression with increased mortality is widely demonstrated in patients with cardiovascular disease (CVD) in a previous meta-analysis[1 2] as well as its association with poor cardiac prognosis. Conclusion The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms
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