Chronic Disease

Patient hopelessness is linked to poor participation in cardiac rehabilitation exercise

Depression and hopelessness can affect the development and progression of heart disease. For example, symptoms of hopelessness are associated with a higher risk of fatal and nonfatal heart disease. Now, a new study finds that patients who feel hopeless after a heart attack or severe episode of angina (crushing chest pain) are less likely to participate in exercise as part of their cardiac rehabilitation program. Researchers interviewed 207 patients with acute coronary syndrome (unstable angina or heart attack) at 3 months after hospital discharge and then again at 8 months. All were treated at five community hospitals in central Michigan. A variety of measures were assessed, including the degree of hopelessness and depression, activity status, coexisting conditions (comorbidities), and exercise participation.

Hopelessness, but not depression, predicted lower exercise participation during cardiac rehabilitation. For each additional point on the hopelessness scale used by the researchers, the odds of exercise participation declined by 32 percent. Medicaid patients were less likely than those with private insurance to participate. On the other hand, each additional comorbid condition increased the odds of participation in exercise. There was also more willingness to exercise if a patient had an ejection fraction (a measure of how well the heart pumps) of more than 34 percent.

The findings suggest that hopelessness can be present independent of depression and should be studied separately. Development of interventions to prevent and treat symptoms of hopelessness may contribute to improved recovery of these cardiac patients, suggest the researchers. The study was supported in part by the Agency for Healthcare Research and Quality (HS10531).

See "Hopelessness and its effect on cardiac rehabilitation exercise participation following hospitalization for acute coronary syndrome," by Susan L. Dunn, Ph.D., R.N., Manfred Stommel, Ph.D., William D. Corser, Ph.D., R.N., and Margaret Holmes-Rovner, Ph.D., in the 2009 Journal of Cardiopulmonary Rehabilitation and Prevention 29, pp. 32-39.

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