Coronary artery disease
Meta-Analysis of the Effect of Cardiac Rehabilitation Interventions on Depression Outcomes in Adults 64 Years of Age and Older

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Heart disease is a major cause of hospitalization and is associated with greater impairment than arthritis, diabetes mellitus, or lung disease. Depression is prevalent and a serious co-morbidity in heart disease with negative consequences including higher levels of chronic physical illness, decreased psychological well-being, and increased health care costs. The objective of the study was to examine with meta-analysis the impact of community-based cardiac rehabilitation (CR) treatment on depression outcomes in older adults. Randomized controlled trials comparing patients (≥64 years old) receiving CR to cardiac controls were considered. Meta-analyses were based on 18 studies that met inclusion criteria, comprising 1,926 treatment participants and 1,901 controls. Effect sizes (ESs) ranged from −0.39 (in favor of control group) to 1.09 (in favor of treatment group). Mean weighted ES was 0.28, and 11 studies showed positive ESs. Meta-analysis suggests that most CR programs delivered in the home can significantly mitigate depression symptoms. Tailored interventions combined with psychosocial interventions are likely to be more effective in decreasing depression in older adults with heart disease than usual care.

Section snippets

Methods

We conducted a systematic electronic search of the PsycINFO, PubMed, ClinialTrial.gov, Central Register of Controlled Trials, and CINAHL databases. Relevant treatment trials were searched using the following keywords: depress*, elder*, geri*, heart disease or heart failure, old*, randomized, and trial. We reviewed studies of community-based CR interventions offered in the home or outpatient clinic setting for older adults diagnosed with heart disease. For this review, heart disease was defined

Results

Eighteen studies13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 of an elderly CR patient population were included in the analysis (Table 1). The review was comprised of 9 studies conducted in the United States, 4 studies in the United Kingdom, 2 studies in Canada, 1 study in Italy, 1 study in Japan, and 1 study in Taiwan. In Table 1, each study is assigned a reference number for ease of reading with uniformly extracted data and cited in the reference section. Overall,

Discussion

Overall, the present meta-analysis suggests that community-based CR programs demonstrate a positive impact on depression outcomes ranging from small to large ESs. It also suggests that most in-home trials significantly mitigated depression symptoms. The impact of these interventions may be explained in part to the ability of trained interventionists to screen and detect early medical and mental health symptoms, provide education and behavioral health services, and request prompt consultation

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