TY - JOUR
T1 - Depression, Socioeconomic Factors, and Ethnicity as Predictors of Cardiorespiratory Fitness Before and After Cardiac Rehabilitation
AU - Mikkelsen, Nicolai
AU - Dall, Christian Have
AU - Frederiksen, Marianne
AU - Holdgaard, Annette
AU - Rasmusen, Hanne
AU - Prescott, Eva
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Purpose: To determine whether cardiac patients with psychosocial or socioeconomic problems have lower peak oxygen uptake (o2peak) and whether these factors modify the effect of cardiac rehabilitation (CR). Methods: A retrospective cohort study of patients with ischemic heart disease, valvular heart disease, or heart failure referred for CR. o2peak was assessed by a maximal cardiopulmonary exercise test. Pre-existing depression was defined by use of antidepressants and new-onset depression by a modified Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire at CR intake. Socioeconomic status was defined by educational attainment and working status; ethnicity as Western European or non-Western European. Full data from baseline assessment were available on 1217 patients and follow-up on 861 patients. Results: Mean ± SD o2peak before CR was 21.8 ± 6.8 mL/kg/min. After multivariable adjustment, lower o2peak was associated with lower educational attainment, not working, and non-Western ethnicity but not with depression. Mean improvement of o2peak following CR was 2.4 ± 4.3 mL/kg/min. After multivariable adjustment educational attainment, employment status and ethnicity were significant predictors of improvement of o2peak while depression was not. Conclusion: Education, attachment to the workforce, and ethnicity were all associated with lower o2peak before CR, and the disparity was increased following CR. Having pre-existing depression and new-onset depression did not influence o2peak either before or after CR. These results point to important subgroups in need of specially-tailored rehabilitation programs.
AB - Purpose: To determine whether cardiac patients with psychosocial or socioeconomic problems have lower peak oxygen uptake (o2peak) and whether these factors modify the effect of cardiac rehabilitation (CR). Methods: A retrospective cohort study of patients with ischemic heart disease, valvular heart disease, or heart failure referred for CR. o2peak was assessed by a maximal cardiopulmonary exercise test. Pre-existing depression was defined by use of antidepressants and new-onset depression by a modified Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire at CR intake. Socioeconomic status was defined by educational attainment and working status; ethnicity as Western European or non-Western European. Full data from baseline assessment were available on 1217 patients and follow-up on 861 patients. Results: Mean ± SD o2peak before CR was 21.8 ± 6.8 mL/kg/min. After multivariable adjustment, lower o2peak was associated with lower educational attainment, not working, and non-Western ethnicity but not with depression. Mean improvement of o2peak following CR was 2.4 ± 4.3 mL/kg/min. After multivariable adjustment educational attainment, employment status and ethnicity were significant predictors of improvement of o2peak while depression was not. Conclusion: Education, attachment to the workforce, and ethnicity were all associated with lower o2peak before CR, and the disparity was increased following CR. Having pre-existing depression and new-onset depression did not influence o2peak either before or after CR. These results point to important subgroups in need of specially-tailored rehabilitation programs.
U2 - 10.1097/HCR.0000000000000367
DO - 10.1097/HCR.0000000000000367
M3 - Journal article
C2 - 30489440
SN - 1932-7501
JO - Journal of Cardiopulmonary Rehabilitation and Prevention
JF - Journal of Cardiopulmonary Rehabilitation and Prevention
ER -