The effect of cardiac rehabilitation on anxiety and depression in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) patients



Anxiety, Depression, Cardiac rehabilitation, Coronary artery bypass grafting, Percutaneous coronary intervention


Background/Aim: It is well-known that Cardiac Rehabilitation (CR) brings about a marked improvement in depression and anxiety. As far as we know, there are no studies that research the effect of CR, Percutaneous Coronary Intervention (PCI), and Coronary Artery Bypass Grafting (CABG) on anxiety and depression. This study aimed to investigate the effects of the CR program on anxiety and depression and the change of anxiety and depression symptoms in patients who underwent PCI and CABG. Methods: This cross-sectional study included 27 patients with PCI and 16 patients who had undergone CABG admitted to the CR program. The Beck Depression Inventory (BDI) was used to determine the severity of depression symptoms, and the Situational and Trait Anxiety Inventory (STAI I-II) were used. Results: After CR, the BDI, STAI-1, and STAI-2 significantly decreased in both the PCI (P<0.001, P=0.002, and P=0.006, respectively) and CABG groups (P<0.001, P=0.001, and P=0.015, respectively) compared to before CR. The change in BDI was higher in the CABG group (P=0.033), while there were no significant differences between the changes in STAI-1 and STAI-2 scores (P=0.378 and P=0.361). Conclusion: The results of this study demonstrate the CR benefits for depression and anxiety in patients undergoing CABG and PCI. On the other hand, CABG patients show relatively more benefit in terms of depressive symptoms. Prospective and controlled studies with larger sample sizes are needed to support our findings.


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Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic medicine. 2004;66:802-13.

Kubzansky LD, Kawachi I. Going to the heart of the matter: do negative emotions cause coronary heart disease? Journal of psychosomatic research. 2000;48:323-37.

Taggart DP. Coronary artery bypass grafting is still the best treatment for multivessel and left main disease, but patients need to know. The Annals of thoracic surgery. 2006;82:1966-75.

Soran O, Manchanda A, Schueler S. Percutaneous coronary intervention versus coronary artery bypass surgery in multivessel disease: a current perspective. Interactive cardiovascular and thoracic surgery. 2009;8:666-71.

Sullivan MD, LaCroix AZ, Spertus JA, Hecht J. Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. The American journal of cardiology. 2000;86:1135-8, A6, A9.

Frasure-Smith N, Lespérance F. Reflections on depression as a cardiac risk factor. Psychosomatic medicine. 2005;67:S19-S25.

Gündüz A, Gündoğmuş İ. Üniversite öğrencilerinde çocukluk çağı olumsuz yaşantıları ile otomatik düşünceler, ara inançlar, uyumsuz şemalar, anksiyete ve depresif belirti şiddeti ve yaşam kalitesi arasındaki ilişki. Klinik Psikiyatri Dergisi. 2019;22:424-35.

Van Dijk MR, Utens EM, Dulfer K, Al-Qezweny MN, van Geuns R-J, Daemen J, van Domburg RT. Depression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up. European journal of preventive cardiology. 2016;23:552-8.

Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: A scientific statement from the american heart association exercise, cardiac rehabilitation, and prevention committee, the council on clinical cardiology; the councils on cardiovascular nursing, epidemiology and prevention, and nutrition, physical activity, and metabolism; and the american association of cardiovascular and pulmonary rehabilitation. Circulation. 2007;115:2675-82.

Jolliffe J, Rees K, Taylor R, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001:CD001800.

Kulcu D, Kurtais Y, Tur B, Gulec S, Seckin B. The effect of cardiac rehabilitation on quality of life, anxiety and depression in patients with congestive heart failure. A randomized controlled trial, short-term results. Europa Medicophysica. 2007;43:489-97.

Solak Ö, Yaman F, Ulaşlı M, Eroğlu S, Akçi Ö, Özkeçeci G, Toktaş H, Dündar Ü. Improvement in quality of life, functional capacity, and depression level after cardiac rehabilitation. Turk J Phys Med Rehab. 2015;61:130-5.

Demir Gündoğmuş P, Topçu Özcan B, Hayıroğlu M, Gündoğmuş İ, Ölçü EB, Uzun M, Orhan AL. The effect of age on outcomes in a cardiac rehabilitation center from Turkey. Archives of the Turkish Society of Cardiology. 2020;48:270-7.

Sharif F, Shoul A, Janati M, Kojuri J, Zare N. The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran. BMC cardiovascular disorders. 2012;12:40.

Hisli N. Beck depresyon envanterinin universite ogrencileri icin gecerliligi, guvenilirligi.(A reliability and validity study of Beck Depression Inventory in a university student sample). J Psychol. 1989;7:3-13.

Öner N, Le Compte A. Durumluk Sürekli Anksiyete Envanteri el kitabı. İstanbul: Boğaziçi Üniversitesi Yayınları. 1985.

Moradian ST, Msc FF. Comparison of hospital anxiety and depression among patients with coronary artery disease based on proposed treatment. Iranian journal of critical care nursing. 2011;4:97-102.

Glazer KM, Emery CF, Frid DJ, Banyasz RE. Psychological predictors of adherence and outcomes among patients in cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention. 2002;22:40-6.

Rutledge T, Redwine LS, Linke SE, Mills PJ. A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. Psychosomatic medicine. 2013;75:335-49.

Gundogmus PD. The effect of gender on anxiety and depressive symptoms in Turkish cardiac rehabilitation patients. Annals of Medical Research. 2019;26:670-5.

Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. Journal of psychosomatic research. 2002;53:897-902.

Kulik JA, Mahler HI. Social support and recovery from surgery. Health Psychology. 1989;8:221.

Ehlert U, Gaab J, Heinrichs M. Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder, and stress-related bodily disorders: the role of the hypothalamus–pituitary–adrenal axis. Biological psychology. 2001;57:141-52.

Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosomatic medicine. 2004;66:305-15.

Gundogmus İ, Algul A, Karagöz A, Kıyançiçek M. PDW and RDW are new parameters for bipolar episodes and unipolar depression. Psychiatry and Clinical Psychopharmacology. 2018;29:1-7.






Research Article

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Demir Gündoğmuş P, Gündoğmuş İbrahim. The effect of cardiac rehabilitation on anxiety and depression in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) patients. J Surg Med [Internet]. 2021 Sep. 1 [cited 2024 Feb. 28];5(9):867-70. Available from: