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Self-reported Mental Health Status in Patients with Acute Coronary Syndrome: A Strong Predictor of Readmission, of Subsequent Anxiety and Depression and of Poor Risk Factor Modification?

Jannik B Bertelsen, Jens Refsgaard, Helle Kanstrup, Søren P Johnsen, Ina Qvist, Bo Christensen and Kent L Christensen

Purpose: The aim of the study was to examine the association between low self-rated mental health before phase II cardiac rehabilitation (CR) and the risk of readmission, anxiety or depression and successful risk factor modification status 12 months after acute coronary syndrome (ACS).
Methods: A prospective follow-up study among patients with ACS verified by angiograms. The patients were 18-80 years of age, had ejection fractions ≥ 40% and had not previously received CR. The patients completed questionnaires on Mental Component Summary (MCS) score and on Hospital Anxiety and Depression Scale (HADS) both before phase II CR, 4 and 12 months after ACS. The patients were assigned into four quartiles according their initial MCS score and compared, using patients in the top quartile as reference group.
Results: At baseline the mean MCS score was 49.5 (SD 11.3) for the 201 included patients. The patients with the lowest MCS score had a higher risk of readmission compared to patients in the highest MCS score quartile (1st vs. 4th quartile) of 52% vs. 28% (OR 0.68, 95% CI 0.52-0.89), anxiety 60% vs. 10% (OR 0.41, 95% CI 0.29-0.56), and depression 44% vs. 0 (OR 0.28, 95% CI 0.17-0.46), respectively, and of achieving recommended blood pressure 62% vs. 82% (OR 0.68, 95% CI 0.51-0.90).
Conclusion: Low self-reported mental health before phase II CR is associated with an increased risk of readmission for cardiovascular disease, for development of anxiety and depression and for not achieving blood pressure targets at 12 months after ACS.