title: Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction: A STUDY OF 158 991 MEDICARE BENEFICIARIES.
abstract: OBJECTIVE
  On the basis of several small studies, depression is often considered a barrier to cardiac rehabilitation (CR) enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI).
  
  
  METHODS
  This was a retrospective study of Medicare beneficiaries with an MI during 2008 (N = 158 991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798. Depression diagnosis was obtained from the International Classification of Diseases, Ninth Revision (ICD-9) codes in the Medicare Provider Analysis and Review (MEDPAR), Outpatient and Carrier Files. The association between depression diagnosis and CR attendance was evaluated using multivariable logistic regression.
  
  
  RESULTS
  Overall, 14% (n = 22 735) of the study population attended CR within 1 year of MI diagnosis. Twenty-eight percent (n = 43 827) had a diagnosis of depression, with 96% of cases documented before enrollment in CR. Twenty-eight percent with a diagnosis of depression compared with 9% without depression attended CR. In adjusted analysis, patients with depression were 3.9 (99% CI, 3.7-4.2) times more likely to attend CR compared with those without depression. Program completion (≥25 sessions) was more common in those with depression (56%) than in those without (35%) (P < .001).
  
  
  CONCLUSIONS
  Diagnosis of depression in Medicare beneficiaries was strongly associated with attending CR and attending more sessions of CR compared with those without depression. Depression is not a barrier to CR participation after MI in Medicare beneficiaries.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, Kent State University, Kent, Ohio (Drs Zullo and Cheruvu); Department of Psychological Sciences, Kent State University, Kent, Ohio (Drs Gathright and Hughes); Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Dr Dolansky); Case Western Reserve University School of Medicine, Harrington Heart & Vascular Institute, Case Medical Center, University Hospitals Health System, Cleveland, Ohio (Dr Josephson); and Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, Ohio (Dr Hughes).
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Zullo
authors.forename: Emily C
authors.initials: EC
authors.lastname: Gathright
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
authors.forename: Richard A
authors.initials: RA
authors.lastname: Josephson
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Cheruvu
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hughes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation / Q000706:statistics & numerical data*; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States