Authors

• Monika Tuzla — Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska — ORCID: 0000-0002-6809-3093
• Jasna Čerkez Habek — Hrvatsko katoličko sveučilište, Zagreb, Hrvatska — ORCID: 0000-0003-3177-3797
• Mario Ivanuša — Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska — ORCID: 0000-0002-6426-6831
• Dubravka Kruhek Leontić — Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska — ORCID: 0000-0001-7899-2044
• Nada Hrstić — Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska — ORCID: 0000-0001-6050-7573
• Goran Krstačić — Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska — ORCID: 0000-0003-0427-7229

Abstract

**Introduction:** Acute myocardial infarction (AMI) is one of the most severe cardiovascular incidents. The treatment, recovery and change in life style in a patient can result in fear, distress, insecurity, anxiety and depression. In order to improve the quality of recovery and reduce the risk of cardiovascular incidents, a cardiovascular rehabilitation program (CVR) is conducted, which, in addition to some other secondary prevention components, also includes a complete psychological care. (1-3) The aim of this study was to determine the incidence of anxiety and depression in patients involved in the outpatient CVR program. **Patients and Methods:** The retrospective study was conducted in the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb. The details about patients were collected for the period from 10th September 2015 to 31st December 2017. The patients with AMI basic diagnosis were divided into three groups: those treated by percutaneous coronary intervention (PCI), those treated by coronary artery bypass surgery (CABG) and those treated by optimal medical therapy (OMT). The structured Hospital Anxiety and Depression Scale (HADS) was used for screening of anxiety and depression at the beginning and end of the program of quarterly outpatient CVR. (2, 3) **Results:** 437 patients were involved in this trial of whom 367 were treated by applying PCI, 50 patients were treated by applying CABG and 20 patients were treated by applying OMT. The results (**Table 1**) show that out of the total number of patients at the beginning of the program, 18% of the them have borderline and clinically significant anxiety, and 22% of them have borderline and clinically significant depression. The values of anxiety at the discharge, compared to the anxiety at the beginning of the outpatient CVR program normalized in 10%, while the values of depression normalized in 11% of patients with AMI. ### TABLE 1: Incidence of borderline and clinically significant anxiety and depression in patients with acute myocardial infarction involved in the outpatient cardiovascular rehabilitation program. | **Results on HADS** ≥8 | **On admission** number (%) | **At discharge** number (%) | **Change** number (%) | | --- | --- | --- | --- | | **All patients with AMI (N=437)** | | | | | Anxiety | 80 (18.3%) | 38 (8.7%) | 42 (-9.6) | | Depression | 98 (22.4%) | 48 (11.0%) | 50 (-11.4) | | **Patients with AMI treated by percutaneous coronary intervention (n=367)** | | | | | Anxiety | 69 (18.8%) | 30 (8.2%) | 39 (-10.6) | | Depression | 83 (22.6%) | 39 (10.6%) | 44 (-12.0) | | **Patients with AMI treated by coronary artery bypass surgery (n=50)** | | | | | Anxiety | 6 (12.0%) | 4 (8.0%) | 2 (-4.0) | | Depression | 9 (18.0%) | 6 (12.0%) | 3 (-6.0) | | **Patients with AMI treated by optimal medical therapy (n=20)** | | | | | Anxiety | 5 (25.0%) | 4 (20.0%) | 1 (-5.0) | | Depression | 6 (30.0%) | 3 (15.0%) | 3 (-15.0) | [†] HADS = Hospital Anxiety and Depression Scale; AMI = acute myocardial infarction. **Conclusion:** Participation in the outpatient CVR program results in a decrease in self-assessed anxiety and depression in patients after AMI. The results of screening by using HADS show a better recovery in a group of patients treated by applying PCI.

Keywords

acute myocardial infarction, anxiety, depression, cardiovascular rehabilitation

DOI

Literature

1. Kruhek Leontić D, Ivanuša M. Complete psychological care for cardiovascular patients undergoing outpatient rehabilitation. Cardiol Croat. 2016;11(10-11):498. https://doi.org/10.15836/ccar2016.498
2. Tuzla M, Ivanuša M, Muminović Ž, Kruhek Leontić D. Screening for anxiety and depression using a hospital anxiety and depression scale in outpatient cardiovascular rehabilitation. Cardiol Croat. 2016;11(10-11):550–1. https://doi.org/10.15836/ccar2016.550
3. Ivanuša M, Narančić Skorić K, Glavaš Vražić S, Kruhek Leontić D, Heinrich K, Mažuran Brkljačić L, et al. Outpatient Cardiovascular Rehabilitation in Croatia. Cardiol Croat. 2015;10(1-2):28–42. https://doi.org/10.15836/ccar.2015.28