Systematic screening for anxiety and depression in cardiac rehabilitation – are we there yet?

Helmark, Charlotte; Harrison, Anna L.; Pedersen, Susanne S.; Doherty, Patrick

doi:10.1016/j.ijcard.2022.02.004

Cited by 18 publications

(18 citation statements)

References 33 publications

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“…Further, there was some resistance among respondents for additional screening due to workload concerns, problematic scoring, and lack of resources. Similar findings have been found in relation to the introduction of additional screening for anxiety and depression in busy settings such as inpatient cardiac units (Celano et al, 2013) and cardiac rehabilitation programmes (Helmark et al, 2022). In contrast, there were a few respondents who were already screening for sleep disorders using formal instruments or could see no problem in adding additional brief tools for this purpose.…”

Section: Discussionsupporting

confidence: 78%

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

Grande

Murphy

Kerr

et al. 2023

Journal of Advanced Nursing

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AimsTo examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings.DesignA qualitative descriptive study. Data were collected via semi‐structured interviews.MethodsIn March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized.ResultsSix themes and 20 sub‐themes were identified. Non‐validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed.ConclusionIntroduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness.ImpactsThe findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post‐cardiac event counselling.Reporting MethodAdherence to COREQ guidelines was maintained.Patient or Public ContributionNo Patient or Public Contribution as this study explored health professionals' experiences only.

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Section: Discussionsupporting

confidence: 78%

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

Grande

Murphy

Kerr

et al. 2023

Journal of Advanced Nursing

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“…Although a recent study has employed HADS to investigate new-onset depressive symptoms by excluding patients with prior history of depression in the cardiac population [ 17 ], this study was not inclusive of COVID-19 data, and also examining the patients with a history of depression remains relevant. Furthermore, the assessment of patients' depressive symptoms is still not at the desired levels [ 18 ], so more research is needed to expand on specific patient populations as the current study aims to do.…”

Section: Introductionmentioning

confidence: 99%

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

Sever

Harrison

Doherty

2022

BMC Cardiovasc Disord

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Background The large-scale changes in cardiac rehabilitation (CR) programme delivery in response to COVID-19 has led to diminished provision. The influence of these service changes on the depression symptoms of patients in CR programmes is unknown. Our study investigated the extent of depressive symptoms prior to and during the COVID-19 periods in patients with a previous history of depression at the start of CR. Methods Use of Registry routine practice data, National Audit of Cardiac Rehabilitation (NACR), from COVID-19 period Feb 2020 and Jan 2021, as well as pre COVID-19 period Feb 2019 and Jan 2020, was extracted. Depressive symptoms were defined according to Hospital Anxiety and Depression Score ≥ 8. Chi-square tests and independent samples t-tests were used to investigate baseline characteristics. Additionally, a binary logistic regression to examine the factors associated with high levels of depressive symptoms. Results In total 3661 patients with a history of depression were included in the analysis. Patients attending CR during COVID-19 were found to be 11% more likely to have high levels of acute depressive symptoms compared to patients attending CR prior to COVID-19. Physical inactivity, increased anxiety, a higher total number of comorbidities, increased weight, and living in the most deprived areas were statistically significant factors associated with high levels of acute depressive symptoms at the start of CR following multivariate adjustments. Conclusion Our research suggests that following a cardiac event patients with prior history of depression have high levels of acute depressive symptoms at CR baseline assessment. This finding exists in both the pre Covid-19 and Covid-19 periods in patients with a history of depression.

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“…Notably, the European Society of Cardiology and American Heart Association have recommended screening for depression as a modifiable risk factor of developing ACS and worsening its prognosis (Lichtman et al, 2014; Vaccarino et al, 2020). Nonetheless, a few studies suggested that assessments of depressive and anxiety symptoms are poorly implemented in clinical management of ACS (Hare et al, 2020; Helmark et al, 2022). Hence, it is crucial to recognize these psychological risk factors and identify important influencing factors to inform targeted strategies to improve health outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…ACS not only impairs patients' physical function, but also psychological health. Recent data from 75,315 patients with ACS in England indicated approximately 33% had clinically significant depressive symptoms and 22% experienced anxiety symptoms (Helmark et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Depressive and anxiety symptoms and illness perception among patients with acute coronary syndrome

Zou

Chair

Zhang

et al. 2023

Journal of Advanced Nursing

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Aims:To evaluate the features of depressive and anxiety symptoms and illness perception and their associations in patients with acute coronary syndrome (ACS).Design: Secondary analysis of data from a cross-sectional study and baseline data from a randomized controlled trial. Methods:From June to July 2019 and June to September 2020, patients with ACS in four public hospitals in China completed measurements of depressive and anxiety symptoms, illness perception, and sociodemographic and clinical characteristics. Data were analysed using univariate and multiple logistic regression analyses.Results: This study included 510 participants (mean age, 61.0 ± 9.9 years; 67.8% male). The prevalence of depressive and anxiety symptoms was 66.3% and 56.5%, respectively. Total score of illness perception was 43.5 ± 9.1 and mean scores of each dimension ranged from 5.5 to 7.6, suggesting relatively negative illness perceptions. The top two perceived causes of illness were negative emotions or stress (27.3%) and dietary habits (25.5%) and 24.7% of participants were unaware of causes regarding their illness. After adjusting for potential confounders, a one-point increase in scores on illness perception regarding consequences and emotional response (range, 0-10) was related to a 22% increased probability of depressive symptoms. Every one-point increase in scores on illness perception related to emotional response, personal control and illness comprehensibility was associated with a 38% increased, 13% decreased and 9% decreased probability of anxiety symptoms, respectively. Conclusion:Depressive and anxiety symptoms are prevalent at high rates in patients with ACS. They have a relatively negative illness perception that is associated with the prevalence of depressive and anxiety symptoms.Impact: This study highlights the importance of screening for depressive and anxiety symptoms in patients with ACS, especially for those with negative illness perceptions.Targeted strategies are imperative to improve patients' health outcomes.

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Systematic screening for anxiety and depression in cardiac rehabilitation – are we there yet?

Cited by 18 publications

References 33 publications

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

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

Depressive and anxiety symptoms and illness perception among patients with acute coronary syndrome

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