Dallas, Texas - Veterans who have post-traumatic stress disorder (PTSD) and/or depression were more likely to use cardiac rehabilitation services after an episode of ischemic heart disease than those who didn’t have PTSD or depression, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

“Prior research has shown that patients with mental health conditions may have a greater risk for cardiovascular diseases, mainly because they are more likely to engage in unhealthy activities such as smoking, lack of exercise, poor diet and not taking medications as prescribed,” said Nirupama Krishnamurthi, M.B.B.S., M.P.H, the study’s lead author and a postdoctoral researcher in the Department of Medicine at the University of California San Francisco. “While cardiac rehab aims to decrease a patient’s risk for cardiovascular events, previous studies have suggested mental health challenges such as depression may create barriers that hinder a patients’ benefit from this service.”

Using electronic health records from the national Veterans Administration Corporate Data Warehouse, researchers identified 86,537 patients (average age 67, mostly white non-Hispanic men) who had been hospitalized for heart attack or coronary revascularization at any of the Veterans Health Administration’s 152 hospitals between 2010 and 2014.

Researchers found:

• Of the 86,537 patients hospitalized for ischemic heart disease, 24% had PTSD and/or depression.
• Those with PTSD and/or depression had higher cardiac rehab participation rates than those without PTSD or depression (11% vs. 8%).
• In comparison to patients without PTSD or depression, the adjusted odds of participation were 24% greater in patients with depression alone, 38% greater in patients with PTSD alone, and 57% greater in patients with both PTSD and depression.

Previous studies found that patients with mental health disorders were less likely to use rehabilitation, but these studies had smaller sample sizes and included only patients who were referred by their doctor, rather than all eligible patients. In the current study, researchers were unable to determine the reason patients with mental health conditions were more likely to use cardiac rehabilitation services because of the limited information available in electronic health records.

“Our study shows that mental health disorders may not be barriers to preventive cardiovascular efforts,” said Krishnamurthi, who conducts her research at the San Francisco Veterans Affairs Medical Center. “In fact, we think that having a mental health condition may actually increase patient engagement in care.”

Co-authors are Mary Whooley, M.D.; David Schopfer, M.D.; and Hui Shen, M.S. Author disclosures are on the manuscript.

The VA Quality Enhancement Research Initiative funded the study.