Benchmarking Depressive Symptoms in Cardiac Rehabilitation

Middleton, William A; Savage, Patrick D.; Khadanga, Sherrie; Rengo, Jason L.; Ades, Philip A.; Gaalema, Diann E.

doi:10.1097/hcr.0000000000000657

Cited by 6 publications

(10 citation statements)

References 49 publications

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“…Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms and PHQ-9 ≥ 10 was accepted as high levels of depressive symptoms. However, previous studies were not inclusive of patients with a prior history of depression attending CR during COVID-19 [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Levels of depressive symptoms in cardiac patients attending cardiac rehabilitation with a history of depression: pre Covid-19 and Covid-19 period comparison

Sever

Harrison

Doherty

2022

BMC Cardiovasc Disord

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Background The large-scale changes in cardiac rehabilitation (CR) programme delivery in response to COVID-19 has led to diminished provision. The influence of these service changes on the depression symptoms of patients in CR programmes is unknown. Our study investigated the extent of depressive symptoms prior to and during the COVID-19 periods in patients with a previous history of depression at the start of CR. Methods Use of Registry routine practice data, National Audit of Cardiac Rehabilitation (NACR), from COVID-19 period Feb 2020 and Jan 2021, as well as pre COVID-19 period Feb 2019 and Jan 2020, was extracted. Depressive symptoms were defined according to Hospital Anxiety and Depression Score ≥ 8. Chi-square tests and independent samples t-tests were used to investigate baseline characteristics. Additionally, a binary logistic regression to examine the factors associated with high levels of depressive symptoms. Results In total 3661 patients with a history of depression were included in the analysis. Patients attending CR during COVID-19 were found to be 11% more likely to have high levels of acute depressive symptoms compared to patients attending CR prior to COVID-19. Physical inactivity, increased anxiety, a higher total number of comorbidities, increased weight, and living in the most deprived areas were statistically significant factors associated with high levels of acute depressive symptoms at the start of CR following multivariate adjustments. Conclusion Our research suggests that following a cardiac event patients with prior history of depression have high levels of acute depressive symptoms at CR baseline assessment. This finding exists in both the pre Covid-19 and Covid-19 periods in patients with a history of depression.

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Section: Discussionmentioning

confidence: 99%

Levels of depressive symptoms in cardiac patients attending cardiac rehabilitation with a history of depression: pre Covid-19 and Covid-19 period comparison

Sever

Harrison

Doherty

2022

BMC Cardiovasc Disord

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“…26,27 In addition, higher depressive symptoms are not only correlated with lower levels of CRF but also predict less improvement in CRF during CR. [28][29][30] Programs must be prepared to either treat psychological symptoms or have a referral program in place. While measuring depression is a core component of CR programming, most programs do not have an intervention in place specifically to treat it.…”

Section: Discussionmentioning

confidence: 99%

“…Depression, itself, is predictive of worse outcomes following an acute cardiac event and predicts early dropout from CR 26,27. In addition, higher depressive symptoms are not only correlated with lower levels of CRF but also predict less improvement in CRF during CR 28–30. Programs must be prepared to either treat psychological symptoms or have a referral program in place.…”

Section: Discussionmentioning

confidence: 99%

Lower-Socioeconomic Status Patients Have Extremely High-Risk Factor Profiles on Entry to Cardiac Rehabilitation

Khadanga,

Savage,

Ades

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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Purpose: Patients with lower socioeconomic status (SES) have higher rates of cardiovascular events, yet are less likely to engage in secondary prevention such as cardiac rehabilitation (CR). Given the low number of lower-SES patients entering CR, characterization of this population has been difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower- and higher-SES patients eligible for secondary prevention. Methods: Demographic and clinical characteristics were prospectively gathered on consecutive individuals entering phase 2 CR from January 2014 to December 2022. Patients were classified as lower SES if they had Medicaid insurance. Statistical methods included chi-square and nonpaired t tests. A P value of <.01 was used to determine significance. Results: The entire cohort consisted of 3131 individuals. Compared with higher-SES patients, lower-SES individuals (n = 405; 13%) were a decade younger (57.1 ± 10.4 vs 67.2 ± 11.2 yr), 5.8 times more likely to be current smokers (29 vs 5%), 1.7 times more likely to have elevated depressive symptoms, and significantly higher body mass index, waist circumference, and glycated hemoglobin A1c, with more abnormal lipid profiles (all Ps < .001). Despite being a decade younger, lower-SES patients had lower measures of cardiorespiratory fitness and self-reported physical function (both Ps < .001). Conclusion: Lower-SES patients have a remarkably prominent high-risk cardiovascular disease profile, resulting in a substantially higher risk for a recurrent coronary event than higher-SES patients. Accordingly, efforts must be made to engage this high-risk population in CR. It is incumbent on CR programs to ensure that they are appropriately equipped to intervene on modifiable risk factors such as low cardiorespiratory fitness, obesity, depression, and smoking.

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“…Studies report that <30% of eligible patients participate in CR 2. Several factors, such as distance, work and family obligations, lack of physician referral, physical disability, depression, and minimal social support, can all serve as barriers for CR engagement 3–5…”

mentioning

confidence: 99%