Rationale:

Reduced adherence to medical treatment regimens has been reported among depressed patients with heart disease, which may help to explain the association of depression and cardiac risk. Cardiac rehabilitation (CR) has been shown to reduce mortality among cardiac patients, but depressed patients may be less likely to complete CR. This study examined the hypothesis that increased levels of depression would be associated with a failure to complete a 12-week phase II CR program.

Method:

The Beck Depression Inventory (BDI) was prospectively administered to 601 patients at the time of enrollment in CR. Completion of the 12-week CR program was then coded. Because there are a number of possible outcomes (eg, early discharge for return to work, hospitalization, drop out), completion was dichotomized as "favorable completion" and "failure to favorably complete" CR.

Results:

Participants were 70% male and averaged 66 years of age (range 28-89). A high percentage of patients completed CR (78%). A logistic regression showed that BDI score was associated with failure to complete CR (P < .01), after controlling for age (P < .01) and gender (P =.11). Patients who failed to favorably complete cardiac rehab had significantly higher BDI scores (M = 9.0, SD = 7.3) compared to completers (M = 6.6, SD = 6.2). Although women had higher BDI scores (M = 8.6, SD = 7.4) than men (M = 6.4, SD = 6.1) at entry to CR, gender did not predict failure to complete CR.

Conclusion:

Higher levels of depressive symptoms predicted failure to favorably complete the CR program, which is consistent with at least one earlier report. Lower completion rates by patients who reported higher levels of depression supports the theory treatment adherence may be a mechanism by which depression is associated with increased mortality among cardiac patients. However, the overall completion rate was high, suggesting that few patients drop out of CR.