In the JournalsPerspective

Anxiety, depression may reduce adherence to cardiac rehabilitation

Angela Rao

With World Mental Health Day on Oct. 10, cardiologists should take the mental health of their patients into consideration, as a recent study published in the European Journal of Preventive Cardiology found that patients with anxiety, stress or depression who were participating in a cardiac rehabilitation program were more likely to drop out compared with those without the conditions.

“It highlights the need for clinicians to consistently screen for depression and anxiety before and after cardiac rehabilitation to identify which of these patients have additional support needs,” Angela Rao, RN, PhD candidate at the University of Technology Sydney, told Healio. “Clinicians also need to consider integrating psychological support strategies such as cognitive behavior therapies, meditation and mindfulness into cardiac rehabilitation programs in line with the American Heart Association recommendations.”

Researchers analyzed data from 5,908 patients with ACS or HF who participated in cardiac rehabilitation in two hospitals in Australia between 2006 and 2017. Health status was assessed with SF-36 Quality of Life measures along with subscales such as physical functioning, general health and mental health. Other data that were analyzed include demographic characteristics, risk factors, heart disease diagnosis, current medications and physiological assessment. A psychological assessment was also performed with Depression Anxiety Stress Scale.

Of the patients who entered cardiac rehabilitation programs, 18% had symptoms of moderate to extremely severe depression, 28% had moderate to extremely severe anxiety and 13% had symptoms of moderate to extremely severe stress.

Compared with patients with normal or mild symptoms, those with moderate anxiety (32% vs. 23%), depression (24% vs. 13%) or stress (18% vs. 10%) were less likely to adhere to the cardiac rehabilitation program.

“Cardiac rehabilitation is global, and the similar issues with low referral and participation rates that we experience here have also been reported in the U.S. and Europe. Clinicians do not consistently screen people who have experienced a cardiac event for depression or anxiety,” Rao said in an interview.

The strongest predictors of depression were stress (OR = 4.527; 95% CI, 3.315-6.181) and anxiety (OR = 4.395; 95% CI, 3.363-5.744).

The risk for anxiety upon entry into a cardiac rehabilitation program increased with stress (OR = 5.577; 95% CI, 4.006-7.765) and depression (OR = 3.167; 95% CI, 2.411-4.161) even more so than CV risk factors, sociodemographic factors, quality of life and diagnoses.

“We need to explore what support health professionals might need to integrate psychological therapies into cardiac rehabilitation programs to empower patients to effectively manage their symptoms,” Rao told Healio. – by Darlene Dobkowski

For more information:

Angela Rao, RN, can be reached at angela.rao@uts.edu.au; Twitter: @angela__rao.

Disclosures: The authors report no relevant financial disclosures.

Angela Rao

With World Mental Health Day on Oct. 10, cardiologists should take the mental health of their patients into consideration, as a recent study published in the European Journal of Preventive Cardiology found that patients with anxiety, stress or depression who were participating in a cardiac rehabilitation program were more likely to drop out compared with those without the conditions.

“It highlights the need for clinicians to consistently screen for depression and anxiety before and after cardiac rehabilitation to identify which of these patients have additional support needs,” Angela Rao, RN, PhD candidate at the University of Technology Sydney, told Healio. “Clinicians also need to consider integrating psychological support strategies such as cognitive behavior therapies, meditation and mindfulness into cardiac rehabilitation programs in line with the American Heart Association recommendations.”

Researchers analyzed data from 5,908 patients with ACS or HF who participated in cardiac rehabilitation in two hospitals in Australia between 2006 and 2017. Health status was assessed with SF-36 Quality of Life measures along with subscales such as physical functioning, general health and mental health. Other data that were analyzed include demographic characteristics, risk factors, heart disease diagnosis, current medications and physiological assessment. A psychological assessment was also performed with Depression Anxiety Stress Scale.

Of the patients who entered cardiac rehabilitation programs, 18% had symptoms of moderate to extremely severe depression, 28% had moderate to extremely severe anxiety and 13% had symptoms of moderate to extremely severe stress.

Compared with patients with normal or mild symptoms, those with moderate anxiety (32% vs. 23%), depression (24% vs. 13%) or stress (18% vs. 10%) were less likely to adhere to the cardiac rehabilitation program.

“Cardiac rehabilitation is global, and the similar issues with low referral and participation rates that we experience here have also been reported in the U.S. and Europe. Clinicians do not consistently screen people who have experienced a cardiac event for depression or anxiety,” Rao said in an interview.

The strongest predictors of depression were stress (OR = 4.527; 95% CI, 3.315-6.181) and anxiety (OR = 4.395; 95% CI, 3.363-5.744).

The risk for anxiety upon entry into a cardiac rehabilitation program increased with stress (OR = 5.577; 95% CI, 4.006-7.765) and depression (OR = 3.167; 95% CI, 2.411-4.161) even more so than CV risk factors, sociodemographic factors, quality of life and diagnoses.

“We need to explore what support health professionals might need to integrate psychological therapies into cardiac rehabilitation programs to empower patients to effectively manage their symptoms,” Rao told Healio. – by Darlene Dobkowski

For more information:

Angela Rao, RN, can be reached at angela.rao@uts.edu.au; Twitter: @angela__rao.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Pam R. Taub

    Pam R. Taub

    Prior research has established that depression is prevalent in patients after MI and in those with HF, and that these patients have a worse prognosis compared with patients without depression. This study adds to the literature by showing that depression and anxiety also impact adherence to cardiac rehabilitation programs.

    These findings suggest that there should be more vigilant monitoring of depression and anxiety symptoms on entry into cardiac rehabilitation programs with the goal of addressing and treating these symptoms which will lead to better adherence to cardiac rehabilitation.

    Further research is needed to understand if a proactive strategy of assessing for and treating depression/anxiety symptoms on entry into cardiac rehabilitation will improve overall adherence and outcomes.

    • Pam R. Taub, MD, FACC
    • Director, Step Family Foundation Cardiovascular Rehabilitation and Wellness Center
      Associate Professor of Medicine
      UC San Diego Health System

    Disclosures: Taub reports she is a consultant/speaker for Amarin, Amgen, Boehringer Ingelheim, Janssen, Novo Nordisk, Pfizer and Sanofi/Regeneron and a stockholder of Cardero Therapeutics.