Prevalence of Depression in Patients With Post-Acute Coronary Syndrome and the Role of Cardiac Rehabilitation in Reducing the Risk of Depression: A Systematic Review

Abstract

Patients with acute myocardial infarction (AMI) or ischaemic heart disease are at risk of developing anxiety and depression. This systematic review aims to identify the various risk factors and the role of cardiac rehabilitation in reducing the risk of depression in patients after AMI. In this review, we included data on the prevalence of depression in patients post-AMI for the years 2016-2017 from a cardiac rehabilitation unit at Morriston Hospital, Swansea, a primary coronary angioplasty centre. Results from our meta-analysis were compared with the findings of previous studies. Our data showed the prevalence of depression to be 14% pre-cardiac rehabilitation and 3% post-cardiac rehabilitation. A meta-analysis of seven studies showed the prevalence to be approximately 20-35% depending on the type of questionnaire or screening method used. Gender, marital status, age, and sedentary lifestyle were found to be risk factors for depression post-acute coronary syndrome (ACS). Females, patients aged >65 years, and those who were single, lived alone, or widowed were at a higher risk of depression, and patients with sedentary lifestyles were more likely to have post-ACS depression. Depression in patients post-myocardial infarction was also associated with increased mortality and morbidity risk as well as higher hospital re-admission and future cardiac events.The meta-analysis showed significant publication bias, studies with negative results were less likely to be published, and the study data were heterogeneous. The pooled estimate for depression estimated using the random-effects model was 1.78 (95% confidence interval = 1.58-2.01).

Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients

“…The findings of the present study suggest that survivors of SCAD-AMI are more likely than their counterparts without SCAD to experience anxiety, depression, distress, and cardiac distress in the 6 mo after their acute event. Importantly, SCAD-AMI remained as a unique predictor of these psychological states even after controlling for previously identified red flags for poor post-event mental health status, namely female sex, younger age, mental health history, social isolation, socioeconomic disadvantage, diabetes, and nonattendance at CR using logistic regression 22,23,25–28,30–33. Therefore, the current findings confirm that the emotional difficulty associated with SCAD cannot be attributed simply to the fact that most patients with SCAD are younger females, or to their increased likelihood of having a mental health history.…”

“…Other known red flags include social isolation, indicated by living alone or self-reported loneliness22,23,27,30 and having diabetes 22,23,31. Attendance at cardiac rehabilitation (CR) has been shown to ameliorate post-event anxiety and depression risk, providing a protective effect 30. Finally, given that SCAD is more likely in women,3,4,20 who as a group have a tendency toward higher distress,15,22,32,33 patient sex also needs to be taken into account when attributing post-event mental health problems to the SCAD event.…”

Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study

“…However, no significant changes were observed in depressive symptoms. A meta-analysis reported that the prevalence of depression after acute coronary syndrome in round 14 improved to 3% after cardiac rehabilitation [ 41 ]. However, the COVID-19 pandemic increased this percentage to 34% [ 42 ].…”

Estimating the prevalence of depression in people with acute coronary syndromes: A systematic review and meta-analysis

“…[7] Previous studies have shown that depression increases the risk of ACS, with a prevalence of about 20% to 35%, and that patients who live alone, are widowed, or sedentary are more likely to develop post-ACS depression. [8,9] A growing body of research is exploring the interrelationship between the 2 disorders and focusing more on 2-way screening for depression and ACS. [10][11][12] However, evidence from current epidemiological studies is limited, and estimates of the prevalence of depression in ACS vary widely across studies.…”

“…[7] Previous studies have shown that depression increases the risk of ACS, with a prevalence of about 20% to 35%, and that patients who live alone, are widowed, or sedentary are more likely to develop post-ACS depression. [8,9]…”