Physical and Psychosocial Effects of Cardiac Rehabilitation Participation in Patients With and those Without Coronary Artery Disease

Document Type : Original Article


Graduate of Master of Medical Sciences in Clinical Investigation Program, Harvard Medical School, Boston, MA and Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University and National Heart Institute of Egypt


Abstract Background: Patients participating in cardiac rehabilitation (CR) referred for coronary artery disease (CAD) diagnoses have improvements in physical capacity and psychological well-being. The primary Aim of Study: Aim of this study is to evaluate and compare exercise capacity and psychological well-being between patients referred to CR for CAD diagnoses and those referred for non-CAD diagnoses. Patients and Methods: Primary endpoint was improvement in 6-minute walking distance (6MWD). Secondary endpoints included change in exercise minutes per week (150 min-utes/week) (EMW 150), depression scores (PHQ9), anxiety scores (GAD7) and overall quality of life (COOP) scores. Results: Between January 2015 and February 2020, 617 patients completed the 12-week-CR program and were divided into: group I (referred for non-CAD diagnosis) (N=188) and group II (referred for CAD diagnosis) (N=429). At the com-pletion of their cardiac rehabilitation program, both groups improved their 6MWD without statistical difference (non-CAD group: +188 (110, 274) feet) vs. +200 (89, 290) feet in CAD group, p=0.86). Improvements in EMW 150 following CR were also similar between both groups (non-CAD group: (%) 54% vs. 51%, in CAD group, p= 0.75). Psychological health scores improved with reduction in GAD7, PHQ9 and COOP scores but changes in scores were not statistically different between both groups. PHQ9 categories showed a significant improvement in the moderate to severe category in patients referred for CAD patients. By adjusting for other covariates, CAD status was not associated with change in 6MWD. Conclusions: Patients referred to CR for non-CAD diag-noses showed a similar and non-inferior improvement in physical and psychological parameters as patients referred for CAD diagnoses. Clinical Implications: The study emphasizes the impor-tance of enrollment of patients in the CR for a wide spectrum of cardiac diseases including non-CAD in addition to CAD.