Systematic screening for anxiety and depression in cardiac rehabilitation – are we there yet?. (1st April 2022)

• Record Type: Journal Article
• Authors: Helmark, Charlotte; Harrison, Alex; Pedersen, Susanne S.; Doherty, Patrick
• Is Part Of: International journal of cardiology. Volume 352(2022)
• Page Start: 65
• Page End: 71
• Publication Date: 2022-04-01
• Subjects: Cardiac rehabilitation -- Screening -- Anxiety -- Depression -- Acute coronary syndrome; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.02.004
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Anxiety and depression are prevalent in 20% of patients with acute coronary syndrome (ACS) and associated with poor outcomes. Guidelines recommend screening for these conditions in cardiac rehabilitation (CR) however, clinical practice is inconsistent. Sparse knowledge exists on determinants for screening. Methods: This observational study used data from the National Audit of Cardiac Rehabilitation from January 2016–December 2019. A multivariate logistic regression model was performed to analyze patient- and provider level determinants for screening for anxiety and depression among patients with ACS. Results: The population consisted of 138, 018 patients, where 82, 507 (59.8%) were screened and 55, 511 (40.2%) were not. Younger age, non-white ethnicity, living in areas of social deprivation, current smoking, body mass index>30, and physical activity<150 min per week were negatively correlated with patients being screened. Compared to patients having a percutaneous coronary intervention, patients undergoing coronary artery bypass grafting or medical treatment were less likely to be screened. History of anxiety, depression, osteoporosis, chronic back problems, and asthma were positively correlated with screening, while chronic obstructive pulmonary disease, diabetes, hypertension, and stroke were negatively correlated with screening. Regarding provider level, certification of CR centers was positively associated with screening, while looking over time data showed an incremental negative trend in screening from 2016 to 2019. Conclusion: We found both patient and provider level determinants of screening for anxiety and depression. Clinical practice is still inconsistent especially for high-risk groups. We recommend systematic screening to enable tailored interventions which in turn may mitigate inequity in health outcomes. Highlights: Screening systematically for anxiety and depression are not fully implemented in CR. Both patient and provider level factors determines the likelihood of screening. Patients from areas of high deprivation are screened significantly less. High-risk groups should be screened to mitigate inequity in CR delivery. Certified CR centers screen significantly more than uncertified centers.