Impact of cardiac rehabilitation on quality of life and depression after acute coronary syndrome.
OBJECTIVE
To evaluate the impact of cardiac rehabilitation programs (CRP) on quality of life (QL) and depression at one-year follow-up after acute coronary syndrome (ACS).


METHODS
Two hundred and three patients, without previous cardiological follow-up and referred to the outpatient clinic after hospitalization for ACS between 9/1/2001 and 12/31/2002, were randomly allocated to a 12-week, 3-times-a-week CRP or standard cardiology follow-up only, after giving their informed consent. Baseline population characteristics were recorded and, in patients with more than 4 years' education, QL and depression were evaluated during hospitalization and at one-year follow-up by self-reported responses to the SF-36 QL survey and the Beck Depression Inventory (BDI) respectively. Analysis was by intention-to-treat.


RESULTS
31 patients randomized to CRP, mean age 56 years (31-80), 84% male (group A) and 95 patients, mean age 58 years (33-86), 83 % male, allocated to standard follow-up (group B), responded to the questionnaires. There were no significant differences between the two groups in any of the variables evaluated by the questionnaires during hospitalization. At one-year evaluation, the average BDI score was lower in the CRP group (8 vs. 11, p = 0.05). The prevalence of depressive symptoms (37.5 vs. 56.1%) or severe depression (3.1% vs. 12.2%) was also lower, in this group, although not significantly. SF-36 found significant differences in the evaluation of Vitality (average 62 points in A vs. 47 in B, p < 0.02) and General Health (57 points in A vs. 46 points in B, p < 0.02); there were no differences in the other parameters evaluated. When the physical and mental health components were analyzed, a significant difference favoring CRP was found in mental health (70.6 vs. 56.9, p = 0.02) but not in physical health (62.9 in A vs. 56.4 in B, NS).


CONCLUSIONS
Despite the small sample size, significant differences favorable to CRP after ACS were found. After one-year follow-up, patients referred to CRP have a better BDI score; the Vitality and General Health parameters, as well as the mental health component evaluated by SF-36, are also significantly improved after CRP.
Bettencourt
Nuno
N
Serviço de Cardiologia do Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. nunobett@netcabo.pt
Dias
Carla
C
Mateus
Pedro
P
Sampaio
Francisco
F
Santos
Lino
L
Adão
Luís
L
Mateus
Carlos
C
Salomé
Nuno
N
Miranda
Fátima
F
Teixeira
Madalena
M
Simões
Lino
L
Ribeiro
Vasco Gama
VG
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications / Q000534:rehabilitation*; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013577:Syndrome