The heterogeneous depression trajectory and its predictors in coronary heart disease patients undergoing home-based cardiac rehabilitation: a cohort study

BACKGROUND: Psychological management, particularly addressing depression, is crucial for the effectiveness of home-based cardiac rehabilitation. This study aimed to explore the depression trajectories of coronary heart disease patients during home-based cardiac rehabilitation, identify trajectories associated with cardiovascular readmission, and integrate them into a heterogeneous depression trajectory while examining its predictors. METHODS: A prospective cohort study was conducted at a large cardiac rehabilitation center in mainland China. Participants completed the Patient Health Questionnaire-9 to assess depression levels during the 6-month home-based cardiac rehabilitation, with monthly follow-ups. Using latent class growth models to explore depression trajectories. The relationship between different trajectories and cardiovascular readmission was determined using Cox proportional hazards regression, identifying heterogeneous depression trajectory. Logistic regression analysis was employed to explore the influencing factors of heterogeneous depression trajectory. RESULTS: A total of 346 eligible patients with coronary heart disease participated in the study. Four distinct depression trajectories were identified: sustained no depression (48.0%), delayed onset (15.9%), low U-shaped depression (25.1%), and sustained depression (11.0%). Depression trajectories significantly impacted cardiovascular readmission rates, with higher risks observed in the delayed onset (HR: 4.707, 95% CI: 1.766-12.544) and sustained depression (HR: 8.832, 95% CI: 3.281-23.773) groups. These two groups were combined and termed heterogeneous depression trajectory. Importantly, education level, number of chronic diseases, resilience, social support, and anxiety were independent predictors of heterogeneous depression trajectory. CONCLUSIONS: Depression trajectories during home-based cardiac rehabilitation are significantly heterogeneous and influence cardiovascular outcomes. Early identification and management of high-risk factors can enhance psychological health and reduce readmission rates.