Relative Importance of Comorbid Psychological Symptoms in Patients with Depressive Symptoms Following Phase II Cardiac Rehabilitation

Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA.
Postgraduate Medicine (Impact Factor: 1.7). 11/2011; 123(6):72-8. DOI: 10.3810/pgm.2011.11.2497
Source: PubMed


Previous research has demonstrated a high prevalence of psychological risk factors in patients with coronary heart disease (CHD), as well as the benefits of cardiac rehabilitation (CR) on psychological distress (PD) in showing its potential to improve mortality. We examined the impact of CR on mortality by anxiety and/or hostility symptoms in a large population of CHD patients with symptoms of depression following CR.
We studied 538 patients with CHD who had completed formal CR. Using a validated questionnaire, symptoms of PD were obtained in 3 domains: anxiety, hostility, and depression. Subjects were divided into 3 groups: nondepressed (n = 502), depression alone (n = 14), and depression with anxiety and/or hostility (n = 22). A multivariate analysis for mortality was performed using a composite PD score (PD = sum of scores for anxiety, depression, and hostility). Subjects were analyzed by total mortality over 3-year follow-up by the National Death Index.
Mortality was significantly higher in the group with depressive symptoms compared with those without depressive symptoms (19% vs 3%; P < 0.0001). The comorbid depressed group had a slight trend toward higher mortality (22.7% [5 of 22 patients] vs 14% [2 of 14 patients]; P = 0.52). After adjusting for age, body mass index (BMI), ejection fraction, exercise tolerance, and sex using Cox proportional regression, the number of psychiatric comorbidities (ie, depression, anxiety, and hostility), as well as the sum of their raw scores, were significantly associated with increased mortality. However, this effect disappeared after adjusting for depression score (comorbidity hazard ratio, 1.7; 95% confidence interval, 1.0-2.8 vs comorbidity hazard ratio, 1.2; 95% confidence interval, 0.4-3.7 after adjusting).
Psychological distress is an independent predictor of mortality in stable CHD patients following CR; although anxiety and hostility may also modulate this effect, the overall impact seems to be mostly mediated through depression. Patients with persistent depression following CR may need further intervention.

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Available from: Carl Lavie, Mar 16, 2015
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    • "( CHD ) and was a predictor of mortality in stable CHD patients following cardiac rehab ( p<0 . 0001 ) ( deSchutter , Lavie , & Milani , 2011 ) . Depression appeared to have the largest impact on mortality outcomes , which highlighted the need to address depressive symptoms after completion of cardiac rehabilitation to improve overall survival ( deSchutter et al . , 2011 ) ."
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    ABSTRACT: Distress is a psychological state that is often observed in patients with chronic disease. Many cancers are considered chronic in nature, with patients experiencing long, disease-free states and intervals of metastatic disease. Distress can negatively affect the biopsychosocial balance in cancer survivors and impede their progress along the cancer trajectory. Distress can also affect medical and psychological outcomes and hinder advancement into long-term survivorship. Distress may contribute to disease progression, although despite research findings, health-care providers seldom screen for indications of persistent or unresolved distress. This article discusses research findings related to the prevalence of distress in multiple chronic diseases. Validated instruments used to screen for distress in cancer survivors, such as the Distress Thermometer and symptom checklist from the National Comprehensive Cancer Network, are reviewed. With the availability of brief and concise instruments to screen for distress, providers have the ability to provide holistic and comprehensive care for cancer survivors. The overall financial impact of cancer-related distress is understudied, although similar psychological studies indicate that prevention or elimination of distress is beneficial. Cancer is a lifelong, chronic disease; patients have ongoing needs and varied sources of distress. As the number of cancer survivors exponentially increases, their psychosocial needs will likewise expand.
    03/2014; 5(2):107-14. DOI:10.6004/jadpro.2014.5.2.9
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    • "With respect to comorbid symptoms and conditions, symptoms of anxiety and formal anxiety disorders are strongly correlated with depression in a wide variety of cardiac populations, as they are in the general population. Elevated symptoms of anxiety are highly prevalent in cardiac patients, including those suffering an ACS [39, 40], those with stable CAD [41], those participating in cardiac rehabilitation [42], and those hospitalized for one of several different cardiac conditions [17]. "
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    Cardiovascular Psychiatry and Neurology 04/2013; 2013:695925. DOI:10.1155/2013/695925
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