Key result
Baseline comorbidities like emphysema are linked to ~34% lower odds of depression improving after cardiac rehab.
Why the study?
Depressive symptoms are common in CVD and tied to adverse outcomes, but whether baseline characteristics determine changes in new-onset post-cardiac event depression following cardiac rehabilitation was unknown.
Do baseline comorbidities and risk factors reduce improvement in depressive symptoms in patients attending cardiac rehabilitation?
Observational (n=64,658)
Yes
Do baseline comorbidities and risk factors reduce improvement in depressive symptoms in patients attending cardiac rehabilitation?
Answers are grounded in this paper and cite their sources.
Patients with new-onset depressive symptoms entering cardiac rehabilitation are less likely to improve if they have multiple comorbidities, smoke, or are physically inactive, highlighting the need for tailored interventions.
BACKGROUND: Patients 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. METHODS: Analysing 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. RESULTS: The 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. CONCLUSION: The 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.
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Sever et al. (2020) conducted an observational in Cardiovascular disease with new-onset depressive symptoms (n=64,658). Baseline comorbidities (e.g., emphysema) vs. Absence of comorbidity was evaluated on Improvement in depressive symptoms following cardiac rehabilitation (transition to HADS <8) (OR 0.665, 95% CI 0.443-0.999, p=0.049). Baseline comorbidities like emphysema (OR 0.665) and stroke, along with physical inactivity and smoking, significantly reduced the likelihood of depressive symptom improvement after cardiac rehab.
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