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Heart and American Journal of Cardiology

Clinical Articles, News & Views

Cardiac rehabilitation – the more the merrier

There is evidence of a dose-response relationship between attendance of cardiac rehabilitation (CR) sessions and long-term mortality, according to a study1 published recently in Heart.

The sample comprised 544 men and women in Victoria, Australia, eligible for CR following myocardial infarction, coronary artery bypass surgery or percutaneous interventions. Participants were tracked for four months after hospital discharge to ascertain CR attendance status. Main outcome measure was all-cause mortality at 14 years ascertained through linkage to the Australian National Death Index.

In total, 281 (52%) men and women attended at least one CR session. There were few significant differences between non-attendees and attendees. After adjustment for age, sex, diagnosis, employment, diabetes and family history, the mortality risk for non-attendees was 58% greater than for attendees. Participants who attended <25% of sessions had a mortality risk more than twice that of participants attending ≥75% of sessions. This association was attenuated after adjusting for current smoking.

This study provides “further evidence for the long-term benefits of CR in a contemporary, heterogeneous population,” say the authors. CR practitioners should encourage smokers to attend CR and provide support for smoking cessation, they add.

Antidepressants and adherence

Antidepressants might increase adherence to cardiac rehabilitation according to another study,2 published recently in the Journal of the American College of Cardiology.

The authors examined a cohort of 26,957 patients who had completed a baseline assessment before participating in an exercise-based cardiac rehabilitation programme. The patients were stratified into three cohorts (nondepressed, depressed unmedicated, and depressed medicated) at baseline, according to a self-reported history of depression and the current use of antidepressants. Risk factors were assessed at baseline and after approximately 12 weeks of programme participation. A self-reported history of depression was present at baseline in 5,172 patients (19.2%).

Of these patients, 2,147 (41.5%) were taking antidepressants. Patients in the nondepressed cohort (49.4% completion) were more likely (p <0.001) to complete the exit assessment than patients in the depressed unmedicated (44.5% completion) or depressed medicated (43.5% completion) cohorts. Patients in all three cohorts who completed the exit assessment showed significant improvement in multiple risk factors.

Moreover, the magnitude of improvement in blood pressure, serum lipids and lipoproteins, fasting glucose, weight, and body mass index was similar (p >0.05) in patients taking antidepressants and those who were not.

Antidepressants do not offset the average magnitude of improvement in multiple atherosclerotic risk factors that occurs with completion of a cardiac rehabilitation programme, the authors conclude.

References

1. Beauchamp A, Worcester M, Ng A, et al. Attendance at cardiac rehabilitation is associated with lower all-cause mortality after 14 years of follow-up. Heart 2012. http://dx.doi.org/10.1136/heartjnl-2012-303022

2. Gordon NF, Habib A, Salmon RD, et al. Effect of exercise-based cardiac rehabilitation on multiple atherosclerotic risk factors in patients taking antidepressant medication. Am J Cardiol 2012. http://dx.doi.org/10.1016/j.amjcard.2012.10.011

Published on: December 20, 2012

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