Cardiac Rehabilitation Effects on Depression in Stable Heart Failure with Reduced Ejection Fraction Patients

Background: Heart failure (HF) is a growing chronic health condition affecting more than 20 million people worldwide. Symptoms of depression are a common co-morbidity affecting as many as 42% of patients with heart failure (HF) and are associated with a poor quality of life and adverse prognosis. Symptoms of depression have negative impacts not only on daily social and domestic activities, but also on hospitalization and mortality rates in HF patients. Cardiac rehabilitation has been shown to reduce the rate of mortality, improve functional capacity, and control reduced depressive symptoms and better clinical outcomes. Objective: to investigate the impact of a 12-week completed cardiac rehabilitation program on depressive symptoms in patients with heart failure with reduced ejection fraction. Patients and Methods: Sixty patients with stable heart failure with reduced ejection fraction (HFrEF) with mild, moderate and severe depressive symptoms were recruited between January 2018 to June 2019 at Ain Shams University hospitals and randomly assigned to whether or not receive a 12 weeks cardiac rehabilitation program. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, behavioral and psychosocial management, and sexual activity education smoking cessation. All patients were personally interviewed for assessment of depression and quality of life before and after study period by Beck's depression inventory – II(BDI-II) and Minnesota living with heart failure questionnaire" (MLHFQ), respectively. Besides, all patients underwent echocardiographic assessment before and after study period. Result: A total of 60 patients in study group were enrolled, 26 (86.7%) males in both groups. There were 22 (73.3%) patients (13 with mild depressive symptoms, 5 with moderate and 4 with severe depressive symptoms) showed significant improvement in BDI-II score (P<0.001), whereas 8 (26.7%) patients only did not improve significantly after exercise period, no patients in the study group showed worsening of his depressive symptoms after completed cardiac rehabilitation program. BDI-II score has significant positive correlation with MLHFQ score (r=0.748, P<0.001). In contrast, only 4 (13.3%) patients (all of them were having mild depressive symptoms) of control group improved significantly regarding depressive symptoms (P<0.001), and the majority of participants 16 (53.3%) patients deteriorated regarding depressive symptoms, and the rest of group 10 (33.3%) patients didn’t show significant improvement of their depressive symptoms according to BDI-II score after the 3 month study period. There was a significant difference when compared BDI-II score at baseline with score after study period for the cardiac rehabilitation group. The BDI-II score difference after study period also was significant between two groups (P <0.001). Conclusion: The results of this study demonstrated that a complete and organized cardiac rehabilitation program improves depressive symptoms, quality of life as well as LVEF in patients with heart failure with reduced ejection fraction. Recommendation: Cardiac rehabilitation should be implemented in routine management of patients with heart failure to improve psychological and physical complication of HF. Keywords: Cardiac Rehabilitation; Depression; Heart Failure