Study Finds One in Five Cardiac Rehab Patients, Depressed, Anxious, or Stressed

Not every patient completes a cardiac rehabilitation program.  A new study published in The World Mental Health Day in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC) reports that patients with depression, anxiety or stress are more likely to drop out of cardiac rehabilitation.

‘”Heart patients living with depression are more likely to feel despondent and hopeless, which reduces their ability to manage their symptoms”’ said study author Angela Rao, of the University of Technology Sydney, Australia in a statement released on Oct. 10. ‘They may minimize successes and exaggerate failures, thereby reducing their motivation to exercise and complete a cardiac rehabilitation program,“ says Rao.

Heart Disease and Depression Photo Credit: U.S. National Library of Medicine

“Anxiety may lead to fear of another cardiac event and stop people from being active,’ Rao continued. ‘Depression and anxiety can also impair the ability to retain new information needed to make health-related behavior changes,” she says.’

Cardiac Rehab Supports Patients After Heart Attack or Procedure

After a heart attack or procedure to open blocked arteries, patients should be supported to quit smoking, take up exercise, improve their diet, reduce stress, and control blood pressure and cholesterol — this can be achieved through cardiac rehabilitation.

The authors say that this retrospective study examined the prevalence and impact of depression, anxiety and stress in patients attending cardiac rehabilitation at two hospitals in Sydney between 2006 and 2017. A total of 4,784 patients completed the Depression Anxiety Stress Scale (DASS-21) questionnaire.

Some 18 percent, 28 percent and 13 percent of participants had moderate to extremely severe depression, anxiety or stress, respectively. Patients with moderate symptoms of depression (24 percent versus 13 percent), anxiety (32 percent versus 23 percent) or stress (18 percent versus 10 percent) were significantly more likely to quit cardiac rehabilitation compared to those with no or mild symptoms.

“Depression can dampen positive intentions to exercise even when receiving support from health professionals and being aware of the benefits,’ said  Rao. ‘People with anxiety may underestimate their abilities — for example to walk on a treadmill during a rehabilitation class,” she adds.

Around one half of those with moderate depression or anxiety who completed cardiac rehabilitation did not show significant improvements in these conditions, reported the findings.

Depression, anxiety and stress were related, with one increasing the likelihood of the other. Patients with anxiety or stress were more than four times more likely to be depressed than those without. Anxiety was three times more common in patients with (versus without) depression and more than five times more frequent in those with (versus without) stress. “These relationships were independent of age, sex, clinical characteristics, medication use and quality of life,,” said Rao.

Rao called on clinicians to screen for depression and anxiety at the start and end of rehabilitation to identify those needing extra help. Stress management, cognitive behavioral therapies, meditation and mindfulness can be included to improve mental health and raise participation. Patients should be asked if they wish to be referred for additional psychological assistance.

Rao concluded: “Patients who attend cardiac rehabilitation programs do better than those who don’t. If you think you may need extra support or are hesitant to seek help, it’s advisable to attend the initial assessment as a first step. There may be options you feel more comfortable with, such as completing a program at home.,” she said.’