Mental and Psycho-social Health and Quality-of-Life Before and After Cardiac Rehabilitation: A Prospective Cohort Study With Comparison to Specific Population Norms

Abstract

Background. Data on mental health improvement after cardiac rehabilitation (CR) are contradicting. The aim was to examine the mental and psycho-social health of patients admitted to our rehabilitation center following hospital treatment for acute coronary syndrome, before and after multidisciplinary CR.Methods. Outcome was measured at admission and discharge by the 36-Item Short Form Survey (SF-36), the Symptom Checklist-90 Revised (SCL-90R), the Coping Strategy Questionnaire (CSQ) and the 6-minute-walking distance test. The patients’ health status was compared with norms of sex-, age- and comorbidity-matched data from the German general population. Score differences from norms were measured by standardized mean differences (SMDs); health changes were quantified by standardized effect sizes (ESs). Their importance for comprehensive assessment was quantified by explorative factor analysis.Results. Of n=70 patients followed-up (male: 79%; mean age: 66.6 years), 79% had ≥3 comorbidities. At baseline, SF-36 Physical functioning (SMD=–0.75), Role physical (–0.90), Social functioning (SMD=–0.44), and Role emotional (SMD=–0.45) were significantly worse than the norm. After CR, almost all scores significantly improved by ES=0.23 (SCL-90R Interpersonal sensitivity) to 1.04 (SF-36 Physical functioning). The strongest factor (up to 41.1% explained variance) for health state and change was the mental health domain, followed by function&pain (up to 26.3%).Conclusions. Normative deficits in physical and psycho-social health were reported at baseline. After CR, at follow-up, all scores, except phobia, showed significant improvement. The comprehensive measurement of bio-psycho-social health should not be limited to depression and anxiety but include, especially, the somatization and social participation dimensions.