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 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
ongoing 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%, had symptoms of moderate to extremely
severe depression. More than one in four, 28%, had symptoms of
moderate to extremely severe anxiety. And more than one in 10, 13%,
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
hospitalization, and omission of screening varies between 29%-68% in
CR programs," they noted.
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The new study should serve as a reminder to both patients and their
doctors, said Dr. 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% of patients still have symptoms after rehab
means physicians need to encourage patients to follow-up with a
psychologist or psychiatrist, McLaughlin said. "This is a perfect
opportunity to make a difference in our patients' lives," she added.
"We need to reinforce the need for mental health treatment. Just as
taking aspirin and statins are important, treatment for depression
and anxiety is critical."
While the paper focuses on patients in cardiac rehab programs, many
patients with depression don't even show up for these programs, said
Kerry Stewart, director of clinical research and exercise physiology
at Johns Hopkins Medicine in Baltimore.
There needs to be more of an effort to get these patients into rehab
because it can help with both physical and mental health symptoms,
Stewart said.
"While you can do a lot of what is done in cardiac rehab at home -
you can walk on a treadmill on your own - you would miss the
benefits of being in a group of people who have gone through what
you are going through," Stewart said. "That provides a social
network that helps everybody. To me that is one of the biggest
benefits of cardiac rehab."
SOURCE: http://bit.ly/2oBp7iV European Journal of Preventive
Cardiology, online October 9, 2019.
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