Abstract

BackgroundDepression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR.MethodsAn observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic.ResultsThe analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male.ConclusionThe research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.

Highlights

  • Depression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD)

  • This study aims to build on the previous work done in this field with a unique population yet to be addressed, patients without history of depression, meaning patients with new onset post heart event depressive symptoms, to examine which patient characteristics are associated with developing new onset depressive symptoms in relation to cardiovascular disease

  • A total of 109,055 patients without prior history of depression who had started cardiac rehabilitation (CR) with valid pre Hospital Anxiety and Depression Scale (HADS) assessments constituted the study population. Of these 109,055 participants 20% were present with new onset depressive symptoms (HADS≥8) and 80% had absence of new onset depressive symptoms (HADS< 8)

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Summary

Introduction

Depression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). Little is known about the patient characteristics associated with new onset post heart event depressive symptoms, medical comorbidities, among cardiac rehabilitation (CR) participants. This paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR. Depression is common after cardiovascular disease (CVD) and is associated with worse prognosis and increased mortality rates [1]. Recent CR and prevention guidelines recommend the assessment of depression under the virtue of being a multicomponent intervention and as a risk factor for poor medical outcomes in CVD patients [1, 5, 9, 10]. HADS is a reliable and validated tool for the assessment of depressive symptoms in CVD patients in different countries including the UK [12, 13]

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