Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?

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.

Effects of Exergaming in Patients with Cardiovascular Disease Compared to Conventional Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

“…It should be noted however, that these authors included studies that used other tools (i.e., modified Barthel index and functional independence measure) to measure patients’ wellbeing. There is evidence that shows that the number of comorbidities could also be affecting the quality of life and mental health scores of these patients [ 67 ]. To a certain degree, this could account for the inconsistent results compared to stroke patients.…”

Levels of depressive symptoms in cardiac patients attending cardiac rehabilitation with a history of depression: pre Covid-19 and Covid-19 period comparison

“…Age, gender, The English Index of Multiple Deprivation (IMD) [ 26 ] and marital status (single/partnered) were patient demographics used in the analysis. IMD was used as a dichotomous variable in the analysis (most deprived quintile/less deprived quintiles), a methodology previously described in detail [ 27 ]. Baseline smoking measurements (Pre-CR) are categorised as to whether the patient was a current smoker or non-smoker.…”

“…Therefore, 01 February 2019 to 31 January 2020 was defined as pre covid, and the following year after the spread of the disease 01 February 2020 to 31 January 2021 was defined as patients attending during the COVID-19 period. The variables included in the current paper have been chosen in line with the literature and baseline clinical variables that were carried out by CR providers which were explained in detail in previous publications [27][28][29].…”

Transitional Care from Hospital to Cardiac Rehabilitation During COVID-19: The Perspectives of Older Adults and Their Healthcare Providers

“…For older adults living with cardiovascular disease, the prevalence of mental health conditions, particularly depression and anxiety, 22 is higher compared to other age groups. 3 Sever and colleagues 23 noted that the characteristics of patients who have a new onset of depressive symptoms can influence the depression outcomes after cardiac rehabilitation. Given that the COVID-19 pandemic has exacerbated feelings of vulnerability, anxiety and helplessness for people living with cardiovascular disease, 24 mental health supports for older adults are critical.…”