Home-based cardiac rehab yields greater mental health and HRQoL gains in heart failure patients with elevated depression

This secondary analysis pooled individual patient data from 263 participants in the REACH-HF HFrEF and HFpEF trials to assess whether baseline depression or anxiety moderated the effects of a home-based cardiac rehabilitation (CR) programme. Patients were randomized to home-based CR plus usual care or to usual care alone, with outcomes assessed at 6-12 months.

At baseline, 62 patients (24%) had elevated depression defined as HADS-D greater than 7, and 86 (33%) had elevated anxiety defined as HADS-A greater than 7. Outcomes included depression and anxiety scores on the Hospital Anxiety and Depression Scale, health-related quality of life measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and HeartQoL, and accelerometer-measured physical activity. Linear regression models adjusted for baseline values, stratification variables, and confounders, and incorporated interaction terms between baseline depression or anxiety and intervention group.

Among patients with elevated baseline depression, significant moderation effects favouring CR were observed for depressive symptoms (HADS-D, P = 0.004), MLHFQ (P = 0.007), and HeartQoL (P = 0.001); no effects were found for physical activity. Among patients with elevated baseline anxiety, significant interactions were seen for HADS-D (P = 0.024), HeartQoL physical (P = 0.04), inactivity (P = 0.02), and light physical activity (P = 0.04), but not for anxiety symptoms or HRQoL measures overall.

The abstract does not report adverse events, tolerability, or discontinuation data. A key limitation is reliance on HADS screening scores rather than diagnostic clinical interviews to define elevated depression or anxiety, which the authors note precludes stronger conclusions about patients with confirmed psychiatric diagnoses. Clinically, these findings suggest that home-based CR may be of particular value for heart failure patients screening positive for depressive symptoms, while benefits in the elevated-anxiety subgroup appear more circumscribed.