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Psychological Stress After Cardiac Rehab

Am J Med; ePub 2016 Jul 29; Kachur, Menezes, et al

Publish date:

Depression is usually associated with other forms of psychological stress after cardiac rehabilitation, which confers additional mortality. This according to a recent study of 1,150 patients with coronary heart disease (CHD) following major CHD events and who had completed formal cardiac rehabilitation and exercise training. Stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression and divided into 3 groups: non-depressed (n=1,072), depression alone (n=18), and depression with anxiety and/or hostility (n=60). All-cause mortality was charted over 161 months of follow-up. Researchers found:

• Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, was frequently associated with either anxiety or hostility (77% or depressed patients; mortality 22.0%).

• Depression alone (HR, 1.73), as well as depression with comorbid psychological stress, was associated with higher mortality (HR, 1.98) after adjustments.

• There was increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR, 2.41).

Citation:

Kachur S, Menezes AR, De Schutter A, Milani RV, Lavie CJ. Significance of comorbid psychological stress and depression on outcomes after cardiac rehabilitation. [Published online ahead of print July 29, 2016]. Am J Med. doi:10.1016/j.amjmed.2016.07.006.

Commentary:

Post-MI depression is associated with increased mortality. This study shows that other associated psychological comorbidities, specifically anxiety and hostility, add to the health dangers associated with depression. We see this in other high risk areas as well—for instance, patients with diabetes and depression have 50% higher mortality rates compared to those without depression.1,2 The take-home point is that depression is common, and in addition to affecting the quality of patients’ lives, it affects their physical outcomes as well and for both reasons is important to address. —Neil Skolnik, MD

  1. Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28:2668–2672.
  2. Lin EH, Heckbert SR, Rutter CM, et al. Depression and increased mortality in diabetes: Unexpected causes of death. Ann Fam Med. 2009:7(5):414-421. i.c:10.1370/afm.998.

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