Abstract
Purpose: Cardiac rehabilitation (CR) improves psychological health and health-related quality of life (HR-QoL). Yet, available evidence suggests that their degree of improvements following CR may depend on patient sex and the mode of revascularization. We examined the interplay between sex and mode of revascularization on the psychological health and HR-QoL of patients completing CR.
Methods: We analyzed the longitudinal records of patients who completed a 3-mo outpatient CR program following coronary revascularization. Levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale and HR-QoL was measured by the Medical Outcomes Study Short Form-36 before and after CR. A two-by-two analysis of covariance (females vs males by coronary artery bypass graft surgery [CABG] vs percutaneous coronary intervention [PCI]) was used to examine the sex-by-revascularization procedure interaction effect on changes in psychological health and HR-QoL.
Results: Of the 278 participants (age: 65 +/- 9 yr) included in the analysis, 191 (69%) underwent PCI and 55 (20%) were females. Following CR, there was a significant sex-by-revascularization procedure interaction effect on anxiety (P = .033) and mental HR-QoL (mental component summary [MCS]; P = .040). Following CABG, females and males showed similar improvements in anxiety (-1.3 +/- 3.4 vs -1.1 +/- 3.6 points, P = .460) and MCS scores (5.4 +/- 8.9 vs 4.5 +/- 8.7 points, P = .887); following PCI, females experienced worse anxiety levels and mental component summary scores while males showed improvements (anxiety: +1.0 +/- 3.8 vs -1.3 +/- 3.8 points, P = .002; MCS: -1.6 +/- 9.3 vs + 4.4 +/- 8.9 points, P = .008, respectively). There was no interaction effect on depression.
Conclusions: Continued efforts are required to improve anxiety and mental HR-QoL in females treated with PCI participating in CR.