Depression in Cardiac Rehabilitation

Abstract Aim: History of comorbid depression (HCD) and new onset depressive symptoms following cardiac event are associated with adverse cardiac events and increased mortality. The purpose of this thesis is to investigate the factors associated with depressive symptoms in patients with HCD and patients with new onset depressive symptoms at baseline cardiac rehabilitation (CR) assessment. In addition, it is also aimed to examine which baseline characteristics determine improvement in depression levels following CR in depressed patients with and without a HCD. Methods: Observational studies using routine clinical data from National Audit of Cardiac Rehabilitation were conducted following a critical review of the literature that identify the known determinants of depression in patients with cardiovascular disease. Logistic regression models were constructed to identify determinants of depressive symptoms measured by hospital anxiety and depression scale (HADS). A survey of CR centres also investigated the extent of psychosocial support offered to CR patients. Results: Around 45% of patients with HCD experienced high levels of depressive symptoms at the start of CR whereas this percentage was around 20% in patients with new onset depression. In patients with HCD, the determinants of reduced likelihood of improvement in depression levels following CR were; smoking, physical inactivity, higher total number of comorbidities, male gender and HADS anxiety score, aligned with the findings of critical review. For those patients with new onset depression the key determinants were; comorbidities of emphysema, stroke, angina, diabetes, higher total number of comorbidities, HADS anxiety score, physical inactivity, and smoking. Conclusion: The baseline characteristics of the patients determining depression outcome following CR has been identified in patients with HCD and patients with new onset depressive symptoms. In order to optimise outcome these patient groups need to be assessed adeptly accounting for their complex multimorbid condition and psychosocial risk factors.