Heart patients with depression, anxiety or stress are more likely to drop out of cardiac rehabilitation, according to a new Australian study published in the European Journal of Preventive Cardiology.
Cardiac rehabilitation is a medically supervised program designed to improve cardiovascular health for patients who have experienced a heart attack, heart failure, angioplasty or heart surgery.
For the study, researchers examined the prevalence and impact of depression, anxiety and stress in patients attending cardiac rehabilitation at two hospitals in Sydney, Australia between 2006 and 2017. A total of 4,784 patients completed the Depression Anxiety Stress Scale questionnaire.
The findings show that approximately 18%, 28% and 13% of participants had moderate to extremely severe depression, anxiety or stress, respectively.
Patients with moderate symptoms of depression (24% versus 13%), anxiety (32% versus 23%) or stress (18% versus 10%) were significantly more likely to quit cardiac rehabilitation compared to those with no or mild symptoms.
“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.
“They may minimize successes and exaggerate failures, thereby reducing their motivation to exercise and complete a cardiac rehabilitation program.”
“Anxiety may lead to fear of another cardiac event and stop people from being active,” she continued. “Depression and anxiety can also impair the ability to retain new information needed to make health-related behavior changes.”
After a heart attack or procedure to open blocked arteries, patients should be encouraged to quit smoking, take up exercise, improve their diet, reduce stress, and control blood pressure and cholesterol; these can be achieved through cardiac rehabilitation.
“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.”
Around one half of patients with moderate depression or anxiety who completed cardiac rehabilitation did not show significant improvements in these conditions.
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 patients with (versus without) stress.
“These relationships were independent of age, sex, clinical characteristics, medication use and quality of life,” said Rao.
Rao urges clinicians to screen for depression and anxiety at the beginning 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.
Source: European Society of Cardiology