The role of depressive and anxiety symptoms in the evaluation of cardiac rehabilitation efficacy after coronary artery bypass grafting surgery.

OBJECTIVES: The aim of this study was to evaluate the efficacy of early 3-week cardiac rehabilitation (CR) in terms of the reduction of negative psychological symptoms, and to determine which factors predispose patients to worse rehabilitation results in this regard.

METHODS: The study involved a random group of 50 patients (11 women and 39 men) who had undergone coronary artery bypass grafting, with a mean age of 63.3 (± 7.2) years. The following screening tests were used: Beck Depression Inventory, State-Trait Anxiety Inventory and Acceptance of Illness Scale. The pulse rate during the first session of physical training was recorded (t(1) P), and after training the patients assessed their level of exertion (t(1) E) on the Borg Scale (BS). The same procedure was repeated at the end of the rehabilitation (t(2) P, t(2) E).

RESULTS: Among the psychological parameters examined at t(1) (at baseline), the strongest relationship with poor acceptance of illness after 3 weeks of rehabilitation was indicated by the level of depression (P < 0.001), with a slightly lower correlation with the state anxiety and the trait anxiety results (P = 0.005 and 0.027, respectively). A relationship was also found between the severity of depression in t(1) and the level of exertion measured by the BS at the end of rehabilitation (P = 0.007). Before rehabilitation, depressed patients exhibited higher levels of both trait and state anxiety (P = 0.009 and 0.018, respectively). After rehabilitation in the depressed subgroup, there was no improvement in the subjective assessment of exertion or reduction of state anxiety. Sex and co-morbidities also had considerable importance in the context of CR efficacy. The women showed more severe depressive symptoms (P = 0.01), a higher personality tendency to anxiety (P = 0.036) and poorer results of rehabilitation (in relation to the level of exertion after physical training and the intensity of state anxiety symptoms). There was no reduction of state anxiety in patients who suffered from at least two co-morbidities.

CONCLUSIONS: The presence of severe anxiety-depressive symptoms before rehabilitation has an effect on its outcome. Psychiatric symptomatology should be diagnosed as early as possible and patients should receive additional therapeutic support.