Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction: A STUDY OF 158 991 MEDICARE BENEFICIARIES.

PURPOSE: 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.

Performance of the Automated Neuropsychological Assessment Metrics (ANAM) in detecting cognitive impairment in heart failure patients.

OBJECTIVE: Evaluate capacity of the Automated Neuropsychological Assessment Metrics (ANAM) to detect cognitive impairment (CI) in heart failure (HF) patients. BACKGROUND: CI is a key prognostic marker in HF. Though the most widely used cognitive screen in HF, the Mini-Mental State Examination (MMSE) is insufficiently sensitive. The ANAM has demonstrated sensitivity to cognitive domains affected by HF, but has not been assessed in this population. METHODS: Investigators administered the ANAM and MMSE to 57 HF patients, compared against a composite model of cognitive function. RESULTS: ANAM efficiency (p < .05) and accuracy scores (p < .001) successfully differentiated CI and non-CI. ANAM efficiency and accuracy scores classified 97.7% and 93.0% of non-CI patients, and 14.3% and 21.4% with CI, respectively. CONCLUSIONS: The ANAM is more effective than the MMSE for detecting CI, but further research is needed to develop a more optimal cognitive screen for routine use in HF patients.

Resource loss predicts depression and anxiety among patients treated with an implantable cardioverter defibrillator.

OBJECTIVE: Many patients treated with an implantable cardioverter defibrillator (ICD) experience clinically significant depression and anxiety after ICD implantation. As ICD use continues to evolve, it is important to understand the correlates of depression and anxiety to identify patients at greatest risk of poor psychological functioning. Conservation of resources theory, a general theory of stress, states that people experience greater stress if they perceive that they are losing personal, social, and material resources. We hypothesized that perceptions of resource loss would be related to symptoms of depression and anxiety after controlling for other known predictors. METHODS: One hundred patients treated with an ICD completed standardized depression and anxiety questionnaires along with questionnaires assessing social support, physical functioning, and resource loss. Clinical variables for patients were obtained from prospectively obtained medical records. RESULTS: Over 20% of the sample exhibited elevated symptoms of depression and anxiety. Patients' depression levels were associated with poor social support, poor physical functioning, a history of depression, and a greater length of time since ICD implantation. Having experienced one or more clinical ICD shocks was related to depression but not anxiety. Higher levels of perceived resource loss were associated with higher levels of both depression and anxiety after controlling for all other predictors. CONCLUSIONS: Resource loss may help to determine psychological distress after ICD implantation. Understanding how resource loss contributes to depression and anxiety may help to identify patients at greatest risk of poor psychological functioning and may suggest treatment strategies.