Abstract 3956: Impact of Cardiac Rehabilitation, Exercise Training, and Fitness on Depression and its Associated Mortality in Coronary Patients
Background - Depression following major coronary heart disease (CHD) events is associated with higher mortality, but little is known whether this excess risk can be reduced through treatment including cardiac rehabilitation and exercise training (CRET).
Methods - We evaluated a consecutive series of 522 patients (381 men, 141 women; age 64±10 years) enrolled in CRET following a major CHD event from January 2000 to July 2005. A control group of 179 patients not completing CRET were independently followed. Depression was assessed by a validated questionnaire at baseline and following CRET, and mortality was evaluated after a mean follow-up of 1,296±551 days.
Results - Overall prevalence of depression decreased by 63% following CRET from 17% to 6% (p<0.0001). Depressed patients following CRET had an over 4-fold higher mortality than non-depressed patients (22% versus 5%, p=0.0004). Depressed patients who completed CRET had a 73% lower mortality (8% versus 30%; p=0.0005) compared to control depressed subjects who did not complete CRET. Reductions in depression and its associated mortality were related to improvements in fitness, however similar reductions were noted in those with either modest (0–10%) or marked (>10%) increases in peak VO2. In multivariate analysis, peak VO2 (Chi-square 14; p=0.0002) and depression (Chi-square 5.7; p=0.02) were independent predictors of survival.
Conclusions -In patients following major CHD events, CRET reduces both depression and the excess mortality associated with depression. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depression and its associated mortality.