Authors

• Monika Tuzla — Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia — ORCID: 0000-0002-6809-3093
• Mario Ivanuša — Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia — ORCID: 0000-0002-6426-6831
• Žaklina Muminović — Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia — ORCID: 0000-0001-6037-7537
• Dubravka Kruhek — Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
• Leontić — Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia — ORCID: 0000-0001-7899-2044

Keywords

anxiety, depression, cardiovascular rehabilitation

DOI

Full Text

**Introduction:** Cardiovascular (CV) diseases and psychiatric disorders are common problems, not only in the general population, but also in patients enrolled in the CV rehabilitation program. The interaction of anxiety and/or depression on CV disease is not only a barrier to conducting the program, but also significantly affects the outcomes of the program. (1, 2) Therefore, timely diagnosis of cardiac and psychiatric symptoms in patients undergoing CV rehabilitation allows adequate treatment which results in the improvement of the quality of life and outcome of the CV disease. This paper aims to show that early screening by using structured HAD scale (Hospital Anxiety and Depression Scale) (3) that evaluates anxiety and depression can help us determine the recovery after the outpatient CV rehabilitation program is completed. **Patients and Methods:** The Institute for Cardiovascular Prevention and Rehabilitation in Zagreb has conducted the retrospective study. All patients undergoing the outpatient CV rehabilitation program were rehabilitated during the period from 10th September 2015 that completed the program prior to 29th September 2016. Demographic data was analyzed. The leading indicators for the enrollment in the program were acute coronary syndrome (group 1), heart surgery treatment (group 2) or cardiac implantable electronic devices (group 3). By using the HAD scale, the patients were tested at the beginning and end of the program. The results were presented by groups by using the descriptive statistics methods. **Results:** The analysis was conducted in a total of 215 patients who completed the program. Most of them were enrolled in group 1 (74.9%), followed by the group 2 (20.0%) and group 3 (5.1%). Demographic characteristics are shown in **Table 1****.** The test results by using the HAD scale at the beginning and end of the CV rehabilitation by groups of patients are shown in **Table 2****.** ### Table 1: Demographic characteristics of patients included in the study. | | **Group 1** | **Group 2** | **Group 3** | **All** | | --- | --- | --- | --- | --- | | *Men* | 126 (78.3%) | 29 (67.4%) | 7 (63.6%) | 162 (75.3%) | | *Women* | 35 (21.7%) | 14 (32.6%) | 4 (36.4%) | 53 (24.7%) | | **All** | 161 | 43 | 11 | 215 | | **Age in years** | | | | | | *(minimum-maximum)* | 35-81 | 41-83 | 50-81 | 35-83 | ### Table 2: Level of anxiety and depression at the beginning and at the end of cardiovascular rehabilitation according to the group of patients. | **All (N = 215)** | **All (N = 215)** | **All (N = 215)** | **All (N = 215)** | **All (N = 215)** | **All (N = 215)** | **All (N = 215)** | | --- | --- | --- | --- | --- | --- | --- | | **Hospital Anxiety and Depression Scale** | **Level of anxiety at the beginning (%)** | **Level of anxiety at the end (%)** | **Change in level of anxiety (%) at the end** | **Level of depression at the beginning (%)** | **Level of depression at the end (%)** | **Change in level of depression (%) at the end** | | **Normal** | 166 (77.2) | 189 (87.9) | +14 | 153 (71.2) | 184 (85.6) | +20 | | **Borderline** **abnormal** | 32 (14.9) | 15 (7.0) | -47 | 36 (16.7) | 18 (8.4) | -50 | | **Abnormal** | 17 (7.9) | 11 (5.1) | -65 | 26 (12.1) | 13 (6.0) | -50 | | **Group 1 (n = 161)** | | | | | | | | **Normal** | 126 (78.3) | 143 (88.9) | +13 | 116 (72.1) | 141 (87.6) | +22 | | **Borderline** **abnormal** | 23 (14.3) | 12 (7.5) | -52 | 27 (16.8) | 11 (6.9) | -41 | | **Abnormal** | 12 (7.5) | 6 (3.8) | -50 | 18 (11.2) | 9 (5.6) | -50 | | **Group 2 (n = 43)** | | | | | | | | **Normal** | 34 (79.1) | 39 (90.7) | +15 | 31 (72.1) | 36 (83.7) | +16 | | **Borderline** **abnormal** | 6 (14.0) | 2 (4.7) | -33 | 7 (16.3) | 5 (11.6) | -71 | | **Abnormal** | 3 (7) | 2 (4.7) | -67 | 5 (11.7) | 2 (4.7) | -40 | | **Group 3 (n = 11)** | | | | | | | | **Normal** | 6 (54.6) | 7 (63.7) | +17 | 6 (54.6) | 7 (63.7) | +17 | | **Borderline** **abnormal** | 3 (27.3) | 1 (9.1) | -33 | 2 (18.2) | 2 (18.2) | 0 | | **Abnormal** | 2 (18.2) | 3 (27.3) | +50 | 3 (27.3) | 2 (18.2) | -67 | **Conclusion:** Most patients enrolled in the CV rehabilitation has a history of some form of acute coronary syndrome (ACS). In addition 3 out of 4 patients enrolled in the program are men. On completion of the rehabilitation program, a large number of patients have normal values of anxiety and depression test results, by using the HAD scale, compared to the test results at beginning of rehabilitation, whereas the number of those with borderline and pathological values has reduced. This trend is present in the groups of those with ACS or those that underwent heart surgeries, but is not recorded in those with implanted electronic devices.

Literature

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