The effect of lifestyle modification on depression amongst myocardial infarction patients after revascularization.
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Date
2020
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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.
Description
Masters Degree. University of KwaZulu-Natal, Durban.