Relative importance of comorbid psychological symptoms in patients with depressive symptoms following phase II cardiac rehabilitation.
ABSTRACT 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.
- SourceAvailable from: Ross Arena[show abstract] [hide abstract]
ABSTRACT: Deaths due to Cardiovascular Disease (CVD) in the United States (US) have reached a plateau during the last four decades and have actually declined slightly in the past two decades; however, CVD remains the leading cause of morbidity and mortality in both women and men in the US and most of the Westernized world . The projected total cost of CVD in the US is over $500 billion dollars (using 2008 dollars) annually and is expected to more than double during the next two decades . Therefore, the prevention and treatment of CVD is of critical importance in the US and worldwide from a medical and economic perspective [1,2]. Considering the staggering fiscal burden of CVD and, especially, Coronary Heart Disease (CHD), most medical treatments are directed at the major CHD risk factors, including obesity and Type 2 Diabetes Mellitus (T2DM) and their epidemics, as well as Hypertension (HTN), dyslipidemia, and smoking. Physical inactivity and, more importantly, physical fitness, defined as a combination of Cardiorespiratory (CRF) and muscular fitness, are often neglected in the equation of major CHD and CVD risk . Substantial evidence supports that physical fitness is one of the most potent predictors of an individual's future health status . More recently, musculoskeletal fitness, along with CRF, have been increasingly recognized to synergistically play major roles in the pathogenesis and prevention of chronic diseases [3-6]. Although we and others have indicated the benefits of muscular strength and muscular fitness on subsequent CVD and total mortality risk, [3,7] as well as the importance of resistance training to improve CVD surrogate outcomes (e.g., improving glucose control in T2DM) , most of the emphasis in the area of physical fitness continues to be directed toward improving levels of CRF [4,6,9].Glycomics and Lipidomics. 01/2012; 2(2):1000e104.
- [show abstract] [hide abstract]
ABSTRACT: In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors-including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities-may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.Cardiovascular Psychiatry and Neurology 01/2013; 2013:695925.