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Publication Briefs

Veterans with PTSD and/or Depression More Likely to Participate in Cardiac Rehabilitation than Veterans without These Disorders

Cardiac rehabilitation (CR) is a cost-effective means of reducing cardiovascular mortality and improving health-related quality of life in patients with ischemic heart disease. Among patient characteristics that may influence participation and adherence to CR, mental health disorders are of particular interest since they have the potential to both increase the risk of cardiovascular disease and to act as a barrier against cardiovascular disease prevention. This study sought to determine whether Veterans with depression and/or PTSD were more or less likely than those without depression or PTSD to participate in CR programs following hospitalization for myocardial infarction (MI) or coronary revascularization. Investigators used VA's national electronic health record to identify all Veterans hospitalized for MI or coronary revascularization at VA hospitals between 2010-2014 (n=86,537). Of these Veterans, 20,372 (24%) experienced PTSD and/or depression. Since only 34 VA facilities had onsite CR programs and it is common practice to refer patients to non-VA programs that are paid for by VA, investigators included both VA and non-VA CR in their analysis. Comorbid conditions, including PTSD and/or depression, were defined as one inpatient or two or more outpatient encounters identified by ICD-9 codes in one year prior to the index hospitalization for MI or coronary revascularization.


  • Veterans with PTSD and/or depression were more likely to participate in CR after hospitalization for MI or coronary revascularization than Veterans without these mental health disorders.
  • Between 2010 and 2014, cardiac rehabilitation participation rates were consistently higher in patients with PTSD or depression (9-12%) than in those without either condition (7-11%)
  • After adjusting for covariates (i.e., sociodemographics), investigators found that in comparison to Veterans without PTSD or depression, the odds of participation in CR were 24% greater in patients with depression alone, 38% greater in patients with PTSD alone, and 57% greater in patients with both PTSD and depression.
  • Investigators were not able to determine why patients with mental disorders were more likely to participate in cardiac rehabilitation.


  • Overall participation in cardiac rehabilitation is low in patients with coronary heart disease, but the presence of PTSD or depression does not reduce participation further. This presents an important opportunity to engage patients with comorbid ischemic heart disease and depression and/or PTSD in collaborative care and preventive efforts to promote a healthy lifestyle, aiming to effectively manage both conditions and reduce future risk of hospitalization for ischemic heart disease.


  • This study relied on data from electronic health records; investigators were unable to validate concurrent depression and PTSD through chart review.
  • Investigators also were unable to determine the severity of depression and PTSD, or to account for medication use.

PubMed Logo Krishnamurthi N, Schopfer DW, Shen H, and Whooley MA. Association of Mental Health Conditions with Participation in Cardiac Rehabilitation. Journal of the American Heart Association. June 4, 2019;8(11):e011639.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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