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Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?
  1. Serdar Sever,
  2. Patrick Doherty,
  3. Su Golder and
  4. Alexander Stephen Harrison
  1. Department of Health Sciences, University of York, York, North Yorkshire, UK
  1. Correspondence to Serdar Sever; ss2284{at}


Background Patients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR.

Methods Analysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population.

Results The analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement.

Conclusion The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.

  • cardiac rehabilitation
  • depression
  • coronary artery disease

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  • Contributors SS and PD contributed to the conception or design of the work. SS, PD, SG and ASH contributed to the acquisition, analysis or interpretation of data for the work. SS, PD, SG and ASH drafted and critically revised the manuscript. All authors gave final approval to be accountable for all aspects of the work, ensuring accuracy and integrity.

  • Funding This research was carried out by the British Heart Foundation (BHF) Cardiovascular Health Research Group, which is supported by a grant from the BHF (grant reference 040/PSS/17/18/NACR).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from the National Audit of Cardiac Rehabilitation, but restrictions apply for the availability of this data, which were used under licence for the current study, as the data is anonymised with NHS Digital under Section 251 and cannot be shared publicly.

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