Zullo Melissa D, Gathright Emily C, Dolansky Mary A, Josephson Richard A, Cheruvu Vinay K, Hughes Joel W
Department of Epidemiology and Biostatistics, College of Public Health, Kent State University, Kent, Ohio (Drs Zullo and Cheruvu); Department of Psychological Sciences, Kent State University, Kent, Ohio (Drs Gathright and Hughes); Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Dr Dolansky); Case Western Reserve University School of Medicine, Harrington Heart & Vascular Institute, Case Medical Center, University Hospitals Health System, Cleveland, Ohio (Dr Josephson); and Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, Ohio (Dr Hughes).
J Cardiopulm Rehabil Prev. 2017 Jan;37(1):22-29. doi: 10.1097/HCR.0000000000000222.
On the basis of several small studies, depression is often considered a barrier to cardiac rehabilitation (CR) enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI).
This was a retrospective study of Medicare beneficiaries with an MI during 2008 (N = 158 991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798. Depression diagnosis was obtained from the International Classification of Diseases, Ninth Revision (ICD-9) codes in the Medicare Provider Analysis and Review (MEDPAR), Outpatient and Carrier Files. The association between depression diagnosis and CR attendance was evaluated using multivariable logistic regression.
Overall, 14% (n = 22 735) of the study population attended CR within 1 year of MI diagnosis. Twenty-eight percent (n = 43 827) had a diagnosis of depression, with 96% of cases documented before enrollment in CR. Twenty-eight percent with a diagnosis of depression compared with 9% without depression attended CR. In adjusted analysis, patients with depression were 3.9 (99% CI, 3.7-4.2) times more likely to attend CR compared with those without depression. Program completion (≥25 sessions) was more common in those with depression (56%) than in those without (35%) (P < .001).
Diagnosis of depression in Medicare beneficiaries was strongly associated with attending CR and attending more sessions of CR compared with those without depression. Depression is not a barrier to CR participation after MI in Medicare beneficiaries.
基于多项小型研究，抑郁症常被视为心脏康复（CR）登记和项目完成的障碍。本研究的目的是在大量近期发生心肌梗死（MI）的医疗保险受益人群中，检验抑郁症诊断与参与CR之间的关联。
这是一项对2008年患有MI的医疗保险受益人的回顾性研究（N = 158991）。使用医疗保健通用程序编码系统#93797或#93798，通过承保人和门诊文件确定CR登记情况。抑郁症诊断从医疗保险提供者分析与审查（MEDPAR）、门诊和承保人文件中的国际疾病分类第九版（ICD - 9）编码中获取。使用多变量逻辑回归评估抑郁症诊断与CR参与情况之间的关联。
总体而言，14%（n = 22735）的研究人群在MI诊断后1年内参加了CR。28%（n = 43827）被诊断为患有抑郁症，其中96%的病例在登记参加CR之前就有记录。被诊断为抑郁症的人群中有28%参加了CR，而未患抑郁症的人群中这一比例为9%。在调整分析中，与未患抑郁症的患者相比，患有抑郁症的患者参加CR的可能性高出3.9倍（99%CI，3.7 - 4.2）。抑郁症患者中项目完成率（≥25次疗程）（56%）比未患抑郁症的患者（35%）更常见（P <.001）。
与未患抑郁症的医疗保险受益人相比，抑郁症诊断与参加CR以及参加更多疗程的CR密切相关。抑郁症并非医疗保险受益人MI后参与CR的障碍。
