Cardiac rehab hampered by depression, anxiety

Anxiety and depression are quite common in patients with cardiac issues, and poor mental health may even cause them to drop out of cardiac rehab programs, a new study found recently. 

According to Australian researchers, one in five patients in cardiac rehab following a heart attack or a procedure to open clogged coronary arteries may suffer from moderate to severe anxiety or depression. Moreover, one in four of those with moderate depression, anxiety or stress symptoms tend to drop out of their cardiac rehabilitation programs. The report was 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."

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 percent had symptoms of moderate to extremely severe depression. More than one in four, 28 percent had symptoms of moderate to extremely severe anxiety. And more than one in 10, 13 percent reported symptoms of moderate to severe stress.

In some patients, rehab does help to improve mental health symptoms, but nearly half of those with moderate anxiety or depression symptoms did not show significant improvement by the end of the program.

Both Australian and American cardiology groups recommend that cardiac rehab patients be screened and referred for treatment of depression and anxiety. However, 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," the report noted.

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 percent 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.