Surprisingly, mental health woes not seen as barrier to veterans' cardiac rehab

Contradicting previous research, a large new study says veterans who had post-traumatic stress disorder or depression were more likely to use cardiac rehabilitation services than those who didn't.

The finding means mental health disorders might not be barriers to preventive cardiovascular efforts, said Nirupama Krishnamurthi, the study's lead author and a postdoctoral researcher in the department of medicine at the University of California, San Francisco. She conducts 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," Krishnamurthi said in a news release.

Patients with mental health conditions may have a greater risk for cardiovascular disease, she said, because they are more likely to smoke, avoid exercise, have poor diets and not take medications.

Previous studies had found that people with mental health disorders were less likely to use cardiac rehabilitation. But those studies had smaller sample sizes and included only patients who were referred by their doctor, rather than all eligible patients.

In the new study, researchers used electronic health records from the national Veterans Administration Corporate Data Warehouse to identify 86,537 people who had been admitted for heart attack or coronary revascularization, such as a bypass or angioplasty at a Veterans Health Administration hospital between 2010 and 2014. Their average age was 67; most were white, non-Hispanic men.

Researchers found that 24% of the patients had PTSD and/or depression – and that 11% of that group had participated in cardiac rehab compared to 8% of those without PTSD or depression.

The study went deeper and analyzed the odds. Compared to vets without PTSD or depression, the adjusted odds of participating in cardiac rehab were 24% higher in those with depression alone; 38% higher in those with PTSD alone; and 57% higher in those with both depression and PTSD.

The study, published Wednesday in the Journal of the American Heart Association, couldn't determine why the veterans with mental health conditions were more likely to use cardiac rehabilitation services. But researchers speculate the greater connection to health care among patients with mental health disorders might offer more opportunities to enroll; or providers might be more likely to refer patients who have poor health behaviors; or the presence of a mental health disorder could increase a patient's interest in the social support aspects of cardiac rehabilitation.

"Although there is need to study this association qualitatively," the authors wrote, "the results compel the exploration of mental health care as an opportunity for primordial and primary prevention of cardiovascular diseases, more colloquially called prehabilitation."