Impact of Completed Cardiac Rehabilitation Program on Depression Level in Patients with Heart Failure with Reduced Ejection Fraction
Authors: Chahat Abdelrahim Saad , Said Khaled Mohamed , Eldin Yasser Alaa , Zahran Mahmoud Mohamed Elsayed 
Published: October 2021

Abstract

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
in this prospective non-randomized study, sixty patients with stable heart failure with reduced ejection fraction with mild, moderate and sever depressive symptoms were recruited between January 2018 to June 2019 at Ain Shams University hospitals and divided into two groups Study group(n = 30); participated in 12-week cardiac rehabilitation program Control group did not participate in cardiac rehabilitation program. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, Behaviors and psychosocial management, Sexual activity education Smoking cessation. All patients 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. Also all of them underwent to echo 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 sever depressive symptoms) showed significant improvement in BDI-II score (P &lt; 0.001), whereas 8 (26.7%) patients only did not improve significantly after exercise period, no one of the study group had been show worsening of his depressive symptoms after completed cardiac rehabilitation program. BDI-II score has significant positive correlation with MLHFQ score (r = 0.748, P &lt; 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 &lt; 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 study period (that was 3 months). There was a significant difference when compared BDI-II score at baseline with score after study period for CR group. The BDI-II score difference after study period also was significant between two groups (P &lt; 0.001).

Conclusion
in conclusion, the results of this prospective, non-randomized study demonstrate that completed CR program improves depressive symptoms, quality of life and 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.