Major Depressive Disorder Predicts Completion, Adherence, and Outcomes in Cardiac Rehabilitation: A Prospective Cohort Study of 195 Patients With Coronary Artery Disease

Article Abstract

Objective: To compare completion, adherence, and cardiac rehabilitation (CR) outcomes between participants with and without major depressive disorder (MDD) undertaking CR.

Method: In a prospective cohort study of consecutive patients with coronary artery disease (n = 195) entering 1-year outpatient CR between January 2006 and August 2008, rates of noncompletion (comprehensive CR criteria), nonadherence (< 70% attendance at scheduled CR visits), and CR outcomes were compared between patients with and without MDD based on the Structured Clinical Interview for DSM-IV criteria.

Results: Major depressive disorder was diagnosed in 22.1% of participants. Rates of noncompletion were 44.2% and 28.9%, and rates of nonadherence were 53.0% and 34.9% for those with and without MDD, respectively. Major depressive disorder was associated with increased risks of noncompletion (multivariate hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.3-4.7) and nonadherence (multivariate HR, 2.4; 95% CI, 1.3-4.2). More participants with MDD failed to complete CR for medical reasons than those without MDD (25.6% vs 12.3%, respectively; P = .031) in post hoc comparisons. Participants with MDD achieved poorer cardiopulmonary fitness increases (change in mean ± SD peak oxygen uptake of 3.3 ± 3.2 vs 6.6 ± 5.7 mL/kg/min; P = .021) and poorer body fat outcomes (a mean ± SD increase of 2.1% ± 4.5% vs a decrease of 0.4% ± 3.4%, P = .009) than those without MDD.

Conclusions: Major depressive disorder was associated with poorer rates of completion and adherence in CR, and it mitigated improvements in clinical outcomes. Despite depression screening and psychosocial support as structured components of care, MDD remained a significant barrier to effective CR.

J Clin Psychiatry

Submitted: October 30, 2009; accepted January 7, 2010.

Online ahead of print: November 2, 2010 (doi:10.4088/JCP.09m05810blu).

Corresponding author: Krista L. Lanctôt, PhD, Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Ste FG05, Toronto, Ontario, Canada, M4N 3M5 (

Volume: 71

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