Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction

Abstract

Purpose-On the basis of several small studies, depression is often considered a barrier to CR enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI).Methods-This was a retrospective study of Medicare Beneficiaries with an MI during 2008 (n=158,991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798. Depression diagnosis was obtained from the ICD-9 codes in the MEDPAR, Outpatient, and Carrier Files. The association between depression diagnosis and CR attendance was evaluated using multivariable logistic regression. HHS Public AccessAuthor manuscript J Cardiopulm Rehabil Prev. Author manuscript; available in PMC 2018 January 01. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptResults-Overall, 14% (n=22,735) of the study population attended CR within 1 year of MI diagnosis. Twenty-eight percent (n=43,827) had a diagnosis of depression with 96% of cases documented prior to enrollment in CR. Twenty-eight percent with a diagnosis of depression compared to 9% without depression attended CR. In adjusted analysis, patients with depression were 3.9 (99% confidence interval: 3.7, 4.2) times more likely to attend CR compared to those without depression. Program completion (≥ 25 sessions) was more common in those with depression (56%) than those without (35%; p < 0.001).

Predicting Adherence to Internet-Delivered Psychotherapy for Symptoms of Depression and Anxiety After Myocardial Infarction: Machine Learning Insights From the U-CARE Heart Randomized Controlled Trial

“…Both symptoms of general cardiac anxiety and specific cardiac fear were among the strongest predictors, and to the extent of symptom and mechanistic overlap, this corroborates previous findings that depression is associated with increased adherence to cardiac rehabilitation [ 43 ]. It is even more likely that cardiac anxiety, which is directly linked to the present treatment, would trigger activity more strongly than depression, given the respective symptomatology.…”

“…We also discovered that novel linguistic predictors based on written verbal responses predicted adherence. The number of words may be a proxy for verbal fluency and degree of patient effort in therapy, and the number of mutual words might be a proxy for the degree of therapeutic alliance, which in part corroborates previous research on therapeutic alliance and other interlinked concepts that promote adherence to iCBT [ 12 , 19 , 20 , 24 , 43 ]. Together with previously known predictors, these linguistic predictors may enable improved risk stratification regarding which patients will likely adhere to treatment.…”

Sequential Combination of Cognitive-Behavioral Treatment and Well-Being Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study)

“…It should also be noted that more than a quarter of the ACS patients diagnosed with depression and/or demoralization (36 out of 136; 26.5%) refused to join the RCT. This percentage, however, is lower than the refusal rates found in the literature on secondary prevention programs, which range from 31.4 [44] to 72.2% [45] among depressed patients. Moreover, about half of the 740 patients initially screened by the cardiologists refused to undergo psychological assessment and almost half of those who agreed refused to join the trial or revoked the initial consent.…”

Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention

“…Similar findings were reported in a retrospective study of 158,991 post-MI patients, in whom depression was strongly associated with CR attendance. 30 Overall, the present study suggests that the patients most in need, i.e. those with the highest level of symptoms of anxiety and depression, are identified and encouraged to participate in CR programmes in Norway.…”