Key result
Cardiac rehabilitation did not significantly affect the trajectory of depressive symptomatology, as all participants experienced spontaneous reductions in depression scores over 1 year.
Why the study?
Does cardiac rehabilitation improve the longitudinal course of depressive symptomatology in patients after a cardiac event?
Observational (n=913)
Yes
Does cardiac rehabilitation improve the longitudinal course of depressive symptomatology in patients after a cardiac event?
p-value: p=0.04
Depressive symptoms are common and undertreated after a cardiac event, and standard cardiac rehabilitation participation does not significantly alter the longitudinal trajectory of these symptoms.
Cardiac rehabilitation should not yet be assumed to improve depressive trajectories post-event; leaves open whether adjunctive interventions are needed beyond spontaneous recovery.
OBJECTIVE: Recent research has linked depression to cardiac mortality, and shown a high burden of persistent depressive symptomatology among cardiac patients. The objective of this study was to longitudinally examine the prevalence and course of depressive symptomatology among women and men for 1 year after a cardiac event, and the effect of cardiac rehabilitation (CR) on this trajectory. METHODS: Nine hundred thirteen unstable angina (UA) and myocardial infarction patients from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months. Measures included CR participation, medication usage, and the Beck Depression Inventory (BDI). The longitudinal analysis was conducted using SAS PROC MIXED. RESULTS: At baseline there were 277 (31.3%) participants with elevated depressive symptomatology (BDI > or = 10), 131 (25.2%) at 6 months, and 107 (21.7%) at 1 year. Overall, approximately 5% were taking an antidepressant medication, and 20% attended CR over their year of recovery. Participants with greater depressive symptomatology participated in significantly fewer CR exercise sessions (r = -0.19, p = .02), and minimal psychosocial interventions were offered. The longitudinal analysis revealed that all participants experienced reduced depressive symptomatology over their year of recovery (p = .04), and younger, UA participants with lower family income fared worst (ps < 0.001). CR did not have an effect on depressive symptomatology over time, but women who attended CR were significantly more depressed than men (p = .01). CONCLUSION: Depressed cardiac patients are undertreated and their symptomatology persists for up to 6 months. CR programs require greater resources to ensure that depressed participants adhere to exercise regimens, and are screened and treated for their elevated symptomatology.
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Grace et al. (2005) conducted an observational in Acute Coronary Syndromes (Myocardial Infarction and Unstable Angina) (n=913). Cardiac rehabilitation vs. No cardiac rehabilitation was evaluated on Change in depressive symptomatology (Beck Depression Inventory score) over 1 year (p=0.04). Cardiac rehabilitation did not significantly affect the trajectory of depressive symptomatology, as all participants experienced spontaneous reductions in depression scores over 1 year.
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