A prospective cohort study of the impact of outpatient Intensive Cardiac Rehabilitation on depression and cardiac self-efficacy

STUDY OBJECTIVE: To evaluate whether an Intensive Cardiac Rehabilitation (ICR) program improves depression and cardiac self-efficacy among patients with a qualifying cardiac diagnosis. DESIGN: Prospective, longitudinal cohort design. SETTING: Single-center, tertiary referral, outpatient cardiac rehabilitation center. PARTICIPANTS: Patients with a qualifying diagnosis for ICR. INTERVENTIONS: Outpatient ICR. MAIN OUTCOME MEASURE(S): Mental health, as assessed using the Patient Health Questionnaire-9 (PHQ-9) and cardiac self-efficacy using the Cardiac Self-Efficacy (CSE) scale. RESULTS: Of the 268 patients included (median age 69 y, 73% men), 70% had no depressive symptoms at baseline (PHQ-9 score <5). PHQ-9 scores improved in the overall sample (p < 0.0001), with greater improvements among patients with mild depressive symptoms at baseline (−4 points, p < 0.001) and those with moderate to severe depressive symptoms at baseline (−5.5 points, p < 0.001). Cardiac self-efficacy improved overall, and the two subsections of the cardiac self-efficacy questionnaire titled, “maintain function” and “control symptoms” improved (all p < 0.001). CONCLUSIONS: Participation in an outpatient ICR program is associated with fewer depressive symptoms and greater cardiac self-efficacy among patients with CVD who qualify for ICR. The improvement in depression was greatest for those with moderate to severe depressive symptoms.