Coronary heart disease and cardiac rehabilitation. Participation rate, predictors and effects on symptoms of anxiety and depression, and employment status of patients following percutaneous coronary intervention - A nationwide prospective cohort study

Abstract

The aims of this thesis were to study CR participation rate, clinically relevant anxiety and depression and employment status of patients following percutaneous coronary intervention (PCI), and the long-term effect of participation in a CR programme on patients’ symptoms of anxiety and depression and their employment status. Using a prospective observational design, we included data from the Norwegian Coronary Stent trial (NorStent) from baseline and 36 months. NorStent was an all-comer study with broad inclusion criteria and few exclusion criteria, conducted at all centres in Norway that perform PCI during 2008 and 2011. A total of 9013 participants were included in NorStent. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) in a representative sample of 775 patients at baseline. At three years follow-up, 7068 patients (82%) responded to a postal survey that included the HADS and questions on CR participation and employment status. This thesis suggests that few patients with established CHD participate in a CR programme, with certain geographical differences. A significant number of patients who have undergone PCI report symptoms of anxiety and depression, with the highest levels found in those participating in a CR programme. After three years, both the CR participants and non-participants had a higher level of anxiety, but not depression, than the general Norwegian population. A significant number of working-age CHD patients were unemployed and CR appeared to have no beneficial effect on clinically relevant symptoms of anxiety and depression or employment status three years after PCI. The present thesis suggest that the patients most in need, i.e. those who are overweight, smokers, and have the highest levels of anxiety and depression, are identified and encouraged to participate in CR programmes.