Depression, anxiety may cause patients to leave cardiac rehab programs

Nearly one in five, 18%, had symptoms of moderate to extremely severe depression.

Anxiety and depression are common among participants in cardiac rehab programs, and that poor mental health may cause them to drop out, a new study finds.

One in five patients in cardiac rehab after a heart attack or a procedure to open clogged coronary arteries may suffer from moderate to severe anxiety or depression, Australian researchers say.

And one in four of those with moderate depression, anxiety or stress symptoms may drop out of their cardiac rehabilitation programs, according to the report published in the European Journal of Preventive Cardiology.

“Health professionals need to provide extras support for those with co-morbid mental health symptoms to enable them to experience the full benefits of physical and mental health that cardiac rehabilitation programs offer,” said lead researcher Angela Rao, a PhD candidate at the University of Technology in Sydney.

“Cardiac rehabilitation programs do refer people to primary care for ongoig management if their psychological symptoms are severe or if people have mental health disorders,” Rao said in an email. “However, half of those with moderate symptoms remain depressed, anxious or stressed on completion of these programs and return to their usual environment without additional support.”
 

To take a closer look at the impact of mental health on cardiac rehab patients, Rao and her colleagues studied 4,784 heart patients treated at two Sydney hospitals between 2006 and 2017. All the patients completed mental health questionnaires upon entering the rehab programs.

Nearly one in five, 18 per cent, had symptoms of moderate to extremely severe depression. More than one in four, 28 per cent, had symptoms of moderate to extremely severe anxiety. And more than one in 10, 13 per cent, reported symptoms of moderate to severe stress.

Rehab appeared to improve mental health symptoms for some patients, but nearly half of those with moderate anxiety or depression symptoms did not show significant improvement by the end of the program. ”

While both Australian and American cardiology groups recommend that cardiac rehab patients be screened and referred for treatment of depression and anxiety, this advice is often not followed in Australia, Rao and colleagues reported. “Standard screening and referral procedures for depression are not standard practice during hospitalisation, and omission of screening varies between 29-68 per cent in CR programs,” they noted.

The new study should serve as a reminder to both patients and their doctors, said Mary Ann McLaughlin, director of Cardiovascular Health and Wellness at Mount Sinai Heart in New York City.

“Physicians should remember depression is a risk factor for cardiovascular disease,” McLaughlin said. “In general, we don’t screen for depression and anxiety as early as we should.”

The finding that 50 per cent of patients still have symptoms after rehab means physicians need to encourage patients to follow-up with a psychologist or psychiatrist, McLaughlin said.