Exercise May Fight Depression in Heart Failure Patients

Story first reported from AJC.com

Exercise helps people with heart failure feel a bit better, physically and emotionally, a new study shows. It may also lower a person's risk of dying or winding up in the hospital.

WebMD For some people, exercise works as well or even better than antidepressants. And you don't have to run a marathon. Just take a walk with a friend. As time goes on, increase activity until you exercise on most days. You'll feel better physically, sleep better at night, and improve your mood.

Up to 40% of people with heart failure grapple with depression . The combination often leads to poor health outcomes. One study found seriously depressed people with heart failure were more than twice as likely to die or be hospitalized over the course of a year compared to other people with heart failure who weren't depressed.

"Whenever patients are more depressed, their motivation goes down. Their ability to keep up with their doctors' recommendations goes down. Their ability to get out and do basic physical activities like walking goes down," as does their health, says David A. Friedman, MD, chief of Heart Failure Services at North Shore-LIJ Plainview Hospital in New York. "It's a vicious cycle."

"This [study] ... shows a non-drug way to try to improve patients' mood and motivation. That's the best thing you can do," says Friedman, who was not involved in the research.

Testing Exercise for Depression

For the study, which is published in the Journal of the American Medical Association, researchers assigned more than 2,322 stable heart failure patients to a program of regular aerobic exercise or usual care. Usual care consisted of information on disease management and general advice to exercise.

The exercise group started with a standard exercise prescription for patients in cardiac rehab: three 30-minute sessions on either a treadmill or stationary bike each week. After three months, they moved to unsupervised workouts at home. At home, their goal was to get 120 minutes of activity a week.

Just as happens in the real world, most exercisers fell short of their weekly goals.

Despite the fact that they weren't as active as they were supposed to be, they still had slightly better scores on a 63-point depression test than the group assigned to usual care. There was a little less than a one-point difference between the two groups. But the differences persisted even after a year, leading researchers to think the result wasn't a fluke.

And the exercisers were about 15% less likely to die or be hospitalized for heart failure compared with the group getting usual care.

Researchers think the differences between the two groups were small because most people in the study weren't depressed to begin with. Only 28% had test scores high enough to indicate clinical depression.

But the more depressed a person was, the more they had to gain from regular exercise. After a year, test scores of depressed patients were about 1.5 points better in the exercise group compared to those assigned to usual care.

"We know that exercise is beneficial in terms of improving cardiovascular fitness. Now we know depression is also reduced in these patients," says researcher James A. Blumenthal, PhD, a professor of psychology and neuroscience at Duke University in Durham, N.C.

"For people who were more depressed, they experienced a greater reduction in their depressive symptoms with exercise," he says.

The study shows exercise "is in the same ballpark" as other established treatments, particularly antidepressant medications, Blumenthal tells WebMD.

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Heart Bypass Surgery Deaths Fall

Story first appeared in the San Francisco Chronicle.

Patient deaths after heart bypass surgeries at California hospitals plummeted 34 percent between 2003 and 2009, newly released statistics show - a drop that may reflect the power of publicly reporting medical results as well as improvements in cardiac care.

Experts believe that having to report the results pushed hospitals to work harder to improve their success numbers in bypass operations, and that one major technique has been turning toward alternatives to the surgery.

That contention seems to be supported in the new statistics, which show that the number of bypass operations declined while alternative procedures - such as less invasive angioplasties and the insertion of stents - were on the rise, along with the use of cholesterol-lowering drugs and other medications.

'Procedure has advanced'

Public reporting has contributed to that decline, but there are a lot of other things going on. The procedure has advanced. It's now a well-studied and well-performed procedure.

The state report on coronary artery bypass graft surgery, which is being made available to the public Tuesday, is now in its sixth year and is still the most detailed measure of any medical procedure in the state. The report relies on 2009 data, the most recent hospital and cause-of-death information available.

In 2009, the report says, the statewide risk-adjusted death rate within 30 days of isolated bypass surgery - not with another procedure like a valve repair - was 1.9 percent. That was a sharp reduction from the 2.9 percent rate in 2003, the first year the state required hospitals to report their results.

Patients are undergoing this procedure less frequently, and when they do undergo it, they have better survival rates.

How Hospitals Rated

California is also one of a handful of states, including Pennsylvania and New York, that require public reporting of the procedure.

There's been a huge focus on improving hospital quality and safety and transparency about the health care system in general.

The California bypass report rated the 119 hospitals that perform the procedure as better, average or worse than the state average on several factors, including death rates and strokes resulting from the surgery. It also rated them, for the first time, on whether patients have to be readmitted because of complications.

While the hospitals generally received average ratings on most of the measures, a few local hospitals stood out.

Alta Bates Summit Medical Center's Oakland hospital received a "better" performance rating for the third year in a row for postoperative strokes, while Good Samaritan Hospital in San Jose performed "worse" on that measure.

Napa's Queen of the Valley Medical Center was the only hospital in the state to get rated as "better" when it came to whether patients had to be readmitted within 30 days of surgery. San Joaquin Community Hospital got dinged on readmissions, while St. Joseph's Medical Center in Stockton did better than average on strokes.


Standardization of care

Much of the hospital's success to a standardization of care that involves the entire team of caregivers, including those who make sure the patient is receiving proper care at home.

But he said the power of public reporting has improved bypass surgery outcomes across the board over the six-year period.

The hospitals that were underperforming have either stopped doing surgery or they were forced to adopt better practices.

Heart bypass surgery in state's hospitals

The California Report on Coronary Artery Bypass Surgery, which relied on 2009 data, found:

-- California hospitals performed 13,260 isolated bypass surgeries in 2009 that did not also involve other surgeries, with 252 deaths.

-- For the first time, the death rate for isolated bypass surgery in 2009 was actually slightly lower than the in-hospital mortality rate for angioplasties and stenting, which are known as a percutaneous coronary intervention. The procedure involves putting tiny tubes called stents into arteries.


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