Veterans with PTSD, depression more likely to participate in cardiac rehab

Mental health disorders like PTSD and depression might not be as much of a barrier to cardiac rehabilitation as was previously thought, according to a study of more than 85,000 U.S. veterans published in the Journal of the American Heart Association.

Lead author Nirupama Krishnamurthi, MBBS, MPH, and colleagues said in JAHA that past research has established a connection between mental illness and an increased risk for CVD—probably because people who struggle with their mental health are more likely to turn to unhealthy habits, like smoking, not exercising, skimping on medications and eating poorly, to manage their symptoms.

“Because the goal of cardiac rehabilitation is to reduce cardiovascular events by addressing poor health behaviors, patients with mental health disorders might greatly benefit from this service,” Krishnamurthi and co-authors wrote. “However, several prior studies have suggested that mental health disorders, particularly depression, may be a barrier to participation.”

Krishnamurthi et al. pulled EHR data for 86,537 patients hospitalized for ischemic heart disease between 2010 and 2014 at any of the Veterans Health Administration’s 152 hospitals in the U.S. Of the patient population, which consisted largely of non-Hispanic white males, 24% reported experiencing either PTSD or depression.

Contrary to the results of several other studies, the researchers found veterans with PTSD and depression were actually more likely than those without mental health disorders to participate in cardiac rehab. Participation rates were 11% and 8% in patients with a mental health issue and those without one, respectively.

Compared to those without PTSD or depression, the odds of participating in rehabilitation were 24% higher in patients with one of the conditions, 38% higher in patients with PTSD alone and 57% higher in patients with both PTSD and depression.

“These findings suggest that mental health conditions may not be a barrier to cardiac rehabilitation and that rehabilitation may, in fact, provide an opportunity for greater mental health care and support,” Krishnamurthi and colleagues wrote. “This provides an important opportunity to engage patients with comorbid ischemic heart disease and mental health disorders in collaborative care, aiming to effectively manage both conditions to reduce future cardiovascular risk.”