Abstract
BACKGROUND: Psychosocial and metacognitive factors play a critical role in cardiovascular health, influencing clinical outcomes and adherence to treatment after Cardiac Rehabilitation (CR). This study investigated the effects of an outpatient CR program on anxiety, depression, and Health-Related Quality of Life (HRQoL) in patients with established Cardiovascular Disease (CVD). Furthermore, it examined the contribution of depressive symptoms, anxiety, and dysfunctional metacognitions to patients' perceived HRQoL. METHODS: Data on demographic, psychological, and biomedical variables were obtained from 89 patients with CVD at baseline and upon completion of the CR program. RESULTS: Participation in CR was associated with significant reductions in depressive symptoms and improvements in perceived HRQoL. Importantly, reductions in dysfunctional metacognitive beliefs emerged as the strongest predictor of post-intervention HRQoL, outweighing the predictive contribution of changes in depression and anxiety. DISCUSSION: The results highlight the close interrelationship between psychological distress and maladaptive metacognitions, both of which are strongly associated with patients' perceived HRQoL during CR. CONCLUSIONS: Addressing maladaptive metacognitive processes may represent a promising therapeutic target to optimize psychological adjustment and improve HRQoL in individuals undergoing CR.