title: The association between cardiac rehabilitation and mortality risk for myocardial infarction patients with and without depressive symptoms.
abstract: BACKGROUND
  Post-myocardial infarction (MI) depression is associated with reduced adherence to cardiac rehabilitation (CR) and increased mortality risk. The present study investigated whether all-cause mortality reduction associated with CR is different for MI-patients with and without depressive symptoms.
  
  
  METHODS
  Data of 2198 post-MI patients from the Depression after Myocardial Infarction (DepreMI) study and Myocardial Infarction and Depression Intervention Trial (MIND-IT) was used. Depression was assessed at hospitalization, defined as a score≥10 on the Beck Depression Inventory (BDI). Participation in CR was assessed with a self-report questionnaire, 12 months post-MI. Cox regression was used to estimate hazard ratios (HR) for all-cause mortality, up till 10 years post-MI. Missing data was imputed, using multiple imputation.
  
  
  RESULTS
  878 (52%) Patients attended CR, 517 (26%) patients had a BDI score ≥10, and 379 (18%) patients died during the follow-up period. Overall, CR was not associated with a lower mortality risk (HR: 0.83; 0.54-1.30; p=0.41), adjusted for age, sex, left ventricle ejection fraction, previous MI, and past or current heart failure. However, there was a significant interaction between depression and CR on mortality (HR: 0.49; 0.27-0.90; p=0.02). CR was significantly associated with reduced mortality in depressed patients (HR: 0.48; 0.28-0.84; p=0.01), but not in non-depressed patients (HR: 1.09; 0.63-1.89; p=0.74).
  
  
  CONCLUSIONS
  Patients were not randomized to CR. We had no information about the specific reasons of clinicians to offer CR and about the patients' motives to participate.
  
  
  CONCLUSIONS
  CR was associated with reduced mortality risk only for MI-patients with depression. Clinicians should therefore particularly encourage MI-patients with depression to participate in CR.
authors.affiliation: University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands. Electronic address: m.meurs@umcg.nl.
authors.forename: Maaike
authors.initials: M
authors.lastname: Meurs
authors.affiliation: University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; University of Groningen/University Medical Center Groningen - Department of General Practice, The Netherlands.
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.affiliation: University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
authors.forename: Jerry
authors.initials: J
authors.lastname: van Riezen
authors.affiliation: University of Groningen/University Medical Center Groningen - Department of Internal Medicine, The Netherlands.
authors.forename: Joris P
authors.initials: JP
authors.lastname: Slaets
authors.affiliation: University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; University of Groningen/University Medical Center Groningen - Department of Internal Medicine, The Netherlands.
authors.forename: Judith G M
authors.initials: JG
authors.lastname: Rosmalen
authors.affiliation: University of Groningen/University Medical Center Groningen - Department of Cardiology, Thoraxcenter, The Netherlands.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.affiliation: University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
authors.forename: Annelieke M
authors.initials: AM
authors.lastname: Roest
authors.affiliation: University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016022:Case-Control Studies; D002423:Cause of Death; D003863:Depression / Q000150:complications / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D010555:Personality Inventory; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Cardiac rehabilitation; Depression; Mortality; Myocardial infarction (MI); Prognosis