Associations of mental health disorders with cardiac rehabilitation participation among women and men Veterans

Abstract: Background: Mental health disorders disproportionately impact Veterans compared to their civilian counterparts. We evaluated the impact of mental health disorders on cardiac rehabilitation (CR) participation among women and men Veterans following serious cardiac events. Methods: From a national Veterans Health Administration (VA) cohort, we evaluated CR participation among Veterans who had a myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery by International Classification of Diseases-10 codes (01/2021-12/2022) using electronic health record data. We identified CR participation using current procedural terminology (CPT) codes up to 1 year following the cardiac condition codes. Mental health diagnoses were determined by ICD codes and included post- traumatic stress disorder (PTSD), anxiety, and depression. Students t-test and chi-square tests were used to compare variables. Results: Among 2965 women, 303 (10%) participated in CR; 8,244/80,071 (10%) of men had participated in CR. CR participants were younger than non-participants; this difference was significant for men only (69±10 vs. 72±11 years, p<0.01; women: 64 ±13 vs. 62 ±9). Among women, the prevalence of mental health diagnoses did not differ for CR participants vs. non-participants (PTSD (103 (34%) vs. 775 (29%), anxiety (28 (9%) vs. 299 (11%)), depression (137 (45%) vs. 1,169 (44%)). Among men, a greater proportion of CR participants had PTSD (1,827 (22%) vs. 13,569 (19%), p <0.01) and anxiety (471 (6%) vs. 3,517 (5%), p<0.01); no significant difference was seen for men with depression (2,124 (26%) vs. 17,803 (25%)). Conclusion: VA-based CR participation for women and men Veterans remains markedly low. When evaluating factors that may impact participation, our findings suggest that mental health disorders are much more prevalent among women. However, mental health diagnoses did not differ with CR participation suggesting they may not be a barrier to CR participation for women and men Veterans.

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