CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC_13(11-12)_489 10.15836/ccar2018.489 Extended Abstract Psychological problems of patients involved in the outpatient cardiovascular rehabilitation program Psihološki problemi bolesnika uključenih u program ambulantne kardiovaskularne rehabilitacije https://orcid.org/0000-0002-6809-3093TuzlaMonika12*https://orcid.org/0000-0003-3177-3797Čerkez HabekJasna23https://orcid.org/0000-0002-6426-6831IvanušaMario14https://orcid.org/0000-0001-7899-2044Kruhek LeontićDubravka1https://orcid.org/0000-0001-6050-7573HrstićNada1https://orcid.org/0000-0003-0427-7229KrstačićGoran1 Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Zagreb, Hrvatska Hrvatsko katoličko sveučilište, Zagreb, Hrvatska Klinička bolnica „Sveti Duh“, Zagreb, Hrvatska Veleučilište u Bjelovaru, Bjelovar, Hrvatska Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia Catholic University of Croatia, Zagreb, Croatia University Hospital “Sveti Duh”, Zagreb, Croatia Bjelovar University of Applied Sciences, Bjelovar, Croatia ADDRESS FOR CORRESPONDENCE: Monika Tuzla, Poliklinika za prevenciju kardiovaskularnih bolesti i rehabilitaciju, Draškovićeva 13, HR-10000 Zagreb, Croatia. / Phone: +385-1-4612-290 / E-mail: monikatuzla@gmail.com 112018 13 11-12 489 490 1710201805112018 2018 Croatian Cardiac Society KLJUČNE RIJEČI: akutni infarkt miokardaanksioznostdepresivnostkardiovaskularna rehabilitacija KEYWORDS: acute myocardial infarctionanxietydepressioncardiovascular rehabilitation

Introduction: Acute myocardial infarction (AMI) is one of the most severe cardiovascular incidents. The treatment, recovery and change in life style in a patient can result in fear, distress, insecurity, anxiety and depression. In order to improve the quality of recovery and reduce the risk of cardiovascular incidents, a cardiovascular rehabilitation program (CVR) is conducted, which, in addition to some other secondary prevention components, also includes a complete psychological care. (1-3) The aim of this study was to determine the incidence of anxiety and depression in patients involved in the outpatient CVR program.

Patients and Methods: The retrospective study was conducted in the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb. The details about patients were collected for the period from 10th September 2015 to 31st December 2017. The patients with AMI basic diagnosis were divided into three groups: those treated by percutaneous coronary intervention (PCI), those treated by coronary artery bypass surgery (CABG) and those treated by optimal medical therapy (OMT). The structured Hospital Anxiety and Depression Scale (HADS) was used for screening of anxiety and depression at the beginning and end of the program of quarterly outpatient CVR. (2, 3)

Results: 437 patients were involved in this trial of whom 367 were treated by applying PCI, 50 patients were treated by applying CABG and 20 patients were treated by applying OMT. The results (Table 1) show that out of the total number of patients at the beginning of the program, 18% of the them have borderline and clinically significant anxiety, and 22% of them have borderline and clinically significant depression. The values of anxiety at the discharge, compared to the anxiety at the beginning of the outpatient CVR program normalized in 10%, while the values of depression normalized in 11% of patients with AMI.

Incidence of borderline and clinically significant anxiety and depression in patients with acute myocardial infarction involved in the outpatient cardiovascular rehabilitation program.
Results on HADS≥8 On admissionnumber (%) At dischargenumber (%) Changenumber (%)
All patients with AMI (N=437)
Anxiety 80 (18.3%) 38 (8.7%) 42 (-9.6)
Depression 98 (22.4%) 48 (11.0%) 50 (-11.4)
Patients with AMI treated by percutaneous coronary intervention (n=367)
Anxiety 69 (18.8%) 30 (8.2%) 39 (-10.6)
Depression 83 (22.6%) 39 (10.6%) 44 (-12.0)
Patients with AMI treated by coronary artery bypass surgery (n=50)
Anxiety 6 (12.0%) 4 (8.0%) 2 (-4.0)
Depression 9 (18.0%) 6 (12.0%) 3 (-6.0)
Patients with AMI treated by optimal medical therapy (n=20)
Anxiety 5 (25.0%) 4 (20.0%) 1 (-5.0)
Depression 6 (30.0%) 3 (15.0%) 3 (-15.0)
HADS = Hospital Anxiety and Depression Scale; AMI = acute myocardial infarction.

Conclusion: Participation in the outpatient CVR program results in a decrease in self-assessed anxiety and depression in patients after AMI. The results of screening by using HADS show a better recovery in a group of patients treated by applying PCI.

LITERATURE Kruhek LeontićDIvanušaM. Complete psychological care for cardiovascular patients undergoing outpatient rehabilitation. Cardiol Croat. 2016;11(10-11):498. 10.15836/ccar2016.498 TuzlaMIvanušaMMuminovićŽKruhek LeontićD. Screening for anxiety and depression using a hospital anxiety and depression scale in outpatient cardiovascular rehabilitation. Cardiol Croat. 2016;11(10-11):550–1. 10.15836/ccar2016.550 IvanušaMNarančić SkorićKGlavaš VražićSKruhek LeontićDHeinrichKMažuran BrkljačićL Outpatient Cardiovascular Rehabilitation in Croatia. Cardiol Croat. 2015;10(1-2):28–42. 10.15836/ccar.2015.28