Depression symptom severity is inversely correlated with CRF, and this correlation is stronger in men than in women. Clinical and prognostic implications of the correlation are discussed. These findings should stimulate further research on the effects of treating one variable on the other.

Patients with heart disease and elevated depressive symptoms may tend to have reduced exercise capacity, and vice versa. This finding has clinical and prognostic implications. It also encourages research on the effects of improving depression on exercise capacity, and vice versa. The effects of potential moderators need to be explored.

Background: This study aimed to (1) confirm cardiac rehabilitation (CR) availability, (2) establish CR density and unmet need, as well as (3) the nature of programs in the Eastern Mediterranean Region (EMR), and (4) compare these (a) by EMR country and (b) to other countries. Methods: In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates. Results: Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year (versus 12 globally). One-third of responding programs were privately funded (n=8; versus globally p<.001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n=378, 36.3% globally; p<.001). Over 80% of programs accepted guideline-indicated patients. Nurses (n=20, 95.2%), cardiologists (n=18, 85.7%) and dietitians (n=18, 85.7%) were the most common healthcare providers on CR teams (mean=6.4±2.2/program; 5.9±2.8 globally, p=.18). On average, programs offered 8.9±1.7/11 core components (versus 8.7±1.9 globally, p=.90). These were most commonly initial assessment, management of risk factors, and patient education (n=21, 100.0% for each), and least commonly return-to-work counselling (n=15 71.4%). Mean dose was 27.0±13.5 sessions (versus 28.7±27.6 globally, p=.38). Seven (33.3%) programs offered some alternative models.