The effect of lifestyle modification on depression amongst myocardial infarction patients after revascularization.

Abstract

Background: Patients with Coronary Artery Disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention (coronary artery bypass graft surgery {CABG} vs percutaneous coronary intervention {PCI}) influences the outcome Objectives: We examined the prevalence of depression and depression traits amongst myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression and depression traits in patients who underwent CABG versus PCI Method: We evaluated the risk factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularization over a 15-month period (Jan 2017 to March 2018). The Beck Depression Inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA). Results: 100 patients were recruited (mean age males 60.73±4.52 yr and females 60.29±3.64 yr), with 5 dropouts leaving 95 patients for complete analysis. Most of the patients were low-income earners 53 (53.0%) and 21.0% had tertiary level education. The majority had multiple CAD risk factors and comorbidities (79.0%). Prior to the LSM program 51 patients (51.0%) had depression and depression traits {CABG 34 (66.7%) vs PCI 17 (33.3%), p = 0.047)}. After LSM the overall prevalence of depression and depression traits fell to 33 patients (34.7%), {PCI 8 (23.0%) vs CABG 25 patients (72.0%), p = 0.001}. The mean depression scores also fell from 21.11±7.75 to 14.98±9.61 (p = 0.002). At baseline PCI patients were more physically active compared to CABG {3 (60.0%) vs 2 patients (40.0%), P = 0.715} respectively. After the LSM, more PCI patients undertook PA compared to CABG {24 (60.0%) vs 14 patients (35.0%) respectively, p = 0.012}. The PA score was also higher amongst the PCI group compared to CABG {14.16±9.73 vs 9.40±10.94 respectively, p = 0.024}. In fully compliant subjects the benefit derived was similar regardless of the mode of intervention {OR 1.10, CI 0.98-4.23,P = 0.191}. Using multivariate analysis the main predictors of depression and depression traits were female gender (OR 3.29, 95% CI 1.51-11.03, p = 0.008), CABG (OR 1.86, 95% CI 1.68-5.77, p = 0.003), heart failure (OR 2.65, 95% CI 5.87-13.62, p = 0.000), Kidney failure (OR 1.41, 95% CI 1.30-5.23, P = 0.041), atrial fibrillation (OR 1.60, 95% CI 1.40-4.77, P = 0.023), low PA (OR 1.97, 95%, CI 11.23- 33.20, P = 0.000), previous history of depression (OR 8.99,95% CI 1.90-7.89, p = 0.002) and low income (OR 2.21, 95% CI 1.40-2.85, p = 0.000). Conclusions: Depression and depression traits are common among subjects undergoing coronary revascularization, more so amongst CABG compared to PCI participants. Lifestyle modification reduces the prevalence of depression and depression traits, with fully compliant CABG vs PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in depression and depression was recorded amongst LSM partlycompliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.