NEW YORK (Reuters Health) – In-home cardiac rehab programs – especially if they are tailored interventions delivered via telehealth technology – can significantly ease depression in older patients, a new meta-analysis shows.
“Overall the studies that we reviewed showed very strong effects,” Dr. Zvi D. Gellis of the University of Pennsylvania in Philadelphia, one of the study’s authors, told Reuters Health. “It’s really important to make referrals for older adults to cardiac rehabilitation programs, because they appear to work.”
Cardiac rehab and psychosocial interventions have been shown to reduce mortality and improve health-related quality of life in patients with heart failure and coronary artery disease, Dr. Gellis and Dr. Christina Kang-Yi, also at UPenn, noted July 27 in the American Journal of Cardiology.
However, they add, few studies have included patients 65 and older, or addressed depression outcomes.
The researchers identified 18 randomized controlled trials that tested community-based cardiac rehabilitation programs and measured depression symptoms. Their analysis included 1,926 treated patients and 1,901 usual-care controls, from six countries.
Fourteen of the trials tested home-based interventions; most of those used telehealth care.
Eleven of the 18 studies showed positive effect sizes for treatment. Overall, the mean weighted effect size was 0.28, with individual studies’ effect sizes ranging from -0.39 for controls to 1.09 in favor of treatment.
From 10% to 25% of older patients with heart disease have depression, Dr. Gellis noted in an interview. In-home cardiac rehab programs are easier for older patients because they don’t require transportation to a hospital or clinic, he pointed out, while at the same time they help patients feel less isolated.
“There’s a team approach with these telehealth community-based programs that you may not see in a hospital based program,” he added.
“Even though these programs work really well across the country, few referrals are made by physicians,” Dr. Gellis said. Participation rates range from 10% to 20% of eligible patients, he and Dr. Kang-Yi note, while older adults, women and minorities are even less likely to be referred for cardiac rehabilitation.
Am J Cardiol 2012.