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Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease.
J Clin Psychiatry. 2011 Sep; 72(9):1181-8.JC

Abstract

OBJECTIVE

To compare completion, adherence, and cardiac rehabilitation (CR) outcomes between participants with and without major depressive disorder (MDD) undertaking CR.

METHOD

In a prospective cohort study of consecutive patients with coronary artery disease (n = 195) entering 1-year outpatient CR between January 2006 and August 2008, rates of noncompletion (comprehensive CR criteria), nonadherence (< 70% attendance at scheduled CR visits), and CR outcomes were compared between patients with and without MDD based on the Structured Clinical Interview for DSM-IV criteria.

RESULTS

Major depressive disorder was diagnosed in 22.1% of participants. Rates of noncompletion were 44.2% and 28.9%, and rates of nonadherence were 53.0% and 34.9% for those with and without MDD, respectively. Major depressive disorder was associated with increased risks of noncompletion (multivariate hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.3-4.7) and nonadherence (multivariate HR, 2.4; 95% CI, 1.3-4.2). More participants with MDD failed to complete CR for medical reasons than those without MDD (25.6% vs 12.3%, respectively; P = .031) in post hoc comparisons. Participants with MDD achieved poorer cardiopulmonary fitness increases (change in mean ± SD peak oxygen uptake of 3.3 ± 3.2 vs 6.6 ± 5.7 mL/kg/min; P = .021) and poorer body fat outcomes (a mean ± SD increase of 2.1% ± 4.5% vs a decrease of 0.4% ± 3.4%, P = .009) than those without MDD.

CONCLUSIONS

Major depressive disorder was associated with poorer rates of completion and adherence in CR, and it mitigated improvements in clinical outcomes. Despite depression screening and psychosocial support as structured components of care, MDD remained a significant barrier to effective CR.

Authors+Show Affiliations

Neuropharmacology Research Group, Sunnybrook Health Sciences Centre, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21208573

Citation

Swardfager, Walter, et al. "Major Depressive Disorder Predicts Completion, Adherence, and Outcomes in Cardiac Rehabilitation: a Prospective Cohort Study of 195 Patients With Coronary Artery Disease." The Journal of Clinical Psychiatry, vol. 72, no. 9, 2011, pp. 1181-8.
Swardfager W, Herrmann N, Marzolini S, et al. Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease. J Clin Psychiatry. 2011;72(9):1181-8.
Swardfager, W., Herrmann, N., Marzolini, S., Saleem, M., Farber, S. B., Kiss, A., Oh, P. I., & Lanctôt, K. L. (2011). Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease. The Journal of Clinical Psychiatry, 72(9), 1181-8. https://doi.org/10.4088/JCP.09m05810blu
Swardfager W, et al. Major Depressive Disorder Predicts Completion, Adherence, and Outcomes in Cardiac Rehabilitation: a Prospective Cohort Study of 195 Patients With Coronary Artery Disease. J Clin Psychiatry. 2011;72(9):1181-8. PubMed PMID: 21208573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease. AU - Swardfager,Walter, AU - Herrmann,Nathan, AU - Marzolini,Susan, AU - Saleem,Mahwesh, AU - Farber,Shale B, AU - Kiss,Alexander, AU - Oh,Paul I, AU - Lanctôt,Krista L, Y1 - 2010/11/02/ PY - 2009/10/30/received PY - 2010/01/07/accepted PY - 2011/1/7/entrez PY - 2011/1/7/pubmed PY - 2011/12/13/medline SP - 1181 EP - 8 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 72 IS - 9 N2 - OBJECTIVE: To compare completion, adherence, and cardiac rehabilitation (CR) outcomes between participants with and without major depressive disorder (MDD) undertaking CR. METHOD: In a prospective cohort study of consecutive patients with coronary artery disease (n = 195) entering 1-year outpatient CR between January 2006 and August 2008, rates of noncompletion (comprehensive CR criteria), nonadherence (< 70% attendance at scheduled CR visits), and CR outcomes were compared between patients with and without MDD based on the Structured Clinical Interview for DSM-IV criteria. RESULTS: Major depressive disorder was diagnosed in 22.1% of participants. Rates of noncompletion were 44.2% and 28.9%, and rates of nonadherence were 53.0% and 34.9% for those with and without MDD, respectively. Major depressive disorder was associated with increased risks of noncompletion (multivariate hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.3-4.7) and nonadherence (multivariate HR, 2.4; 95% CI, 1.3-4.2). More participants with MDD failed to complete CR for medical reasons than those without MDD (25.6% vs 12.3%, respectively; P = .031) in post hoc comparisons. Participants with MDD achieved poorer cardiopulmonary fitness increases (change in mean ± SD peak oxygen uptake of 3.3 ± 3.2 vs 6.6 ± 5.7 mL/kg/min; P = .021) and poorer body fat outcomes (a mean ± SD increase of 2.1% ± 4.5% vs a decrease of 0.4% ± 3.4%, P = .009) than those without MDD. CONCLUSIONS: Major depressive disorder was associated with poorer rates of completion and adherence in CR, and it mitigated improvements in clinical outcomes. Despite depression screening and psychosocial support as structured components of care, MDD remained a significant barrier to effective CR. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/21208573/Major_depressive_disorder_predicts_completion_adherence_and_outcomes_in_cardiac_rehabilitation:_a_prospective_cohort_study_of_195_patients_with_coronary_artery_disease_ L2 - http://www.psychiatrist.com/jcp/article/pages/2011/v72n09/v72n0904.aspx DB - PRIME DP - Unbound Medicine ER -