Depression As an Independent Predictor of Nonadherence to Cardiac Rehabilitation in a Latin American Country

Abstract

Background

Cardiovascular diseases are the leading cause of mortality worldwide, and the primary cause of death from noncommunicable diseases in Colombia. Cardiac rehabilitation programs (CRPs) are effective strategies to reduce cardiovascular mortality, improve functional capacity, and decrease healthcare costs. However, their success depends on patient adherence, which remains suboptimal, particularly in low- and middle-income countries where CRPs are underutilized and understudied. The prognostic impact of anxiety and depression on adherence remains largely unexplored in such countries, where socioeconomic, cultural, and healthcare access barriers may amplify their impact.

Methods

We conducted a retrospective cohort study including patients aged ≥ 18 years who entered a CRP at a Colombian teaching hospital, between 2004 and 2014. Baseline anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Adherence was defined as attending ≥ 30 of 36 sessions. Nested logistic regression models examined the prognostic association between anxiety, depression, and nonadherence, adjusting for demographic and clinical variables.

Results

Among 3659 patients (median age 62 years; 66.2% male), overall nonadherence reached 51.1%. Anxiety was present in 27.9% of patients, and depression in 16.5%. Depression independently predicted nonadherence (odds ratio 1.14; 95% confidence interval: 1.00-1.31), after adjustment for confounders. Anxiety lost its statistical significance in adjusted models (odds ratio 1.06; 95% confidence interval: 0.95-1.19).

Conclusions

Depression at program entry is a modifiable independent predictor of nonadherence in a Latin American CRP. Routine psychological screening and early management of depressive symptoms could enhance adherence and optimize CRPs' effectiveness in resource-limited settings.