Review
Depression and anxiety and outcomes of coronary artery bypass surgery

https://doi.org/10.1016/S0003-4975(02)04391-6Get rights and content

Abstract

Psychological and psychiatric disorders independently increase the risk of cardiovascular disease and worsen the prognosis in patients with established cardiovascular lesions. The objective of this literature review is to discuss recent data concerning the relationships between depression and anxiety and the outcomes of coronary artery bypass grafting. Pathophysiological hypotheses are put forward to explain observed links. We suggest recommendations aimed at improving the psychological evaluation and management of heart surgery candidates, as well as postbypass patients, in the hope of improving quality of life and cardiovascular outcomes in these patients.

Section snippets

Material and methods

The identification of articles in English language peer-reviewed journals was obtained by using PubMed from 1980 to 2001 (www.ncbi.nlm.nih.gov/PubMed), with key words as follow: depression, anxiety, mood disorder, and coronary artery bypass graft surgery. The articles were also identified by searching on any author who had contributed one relevant article and by using the function “related articles” in PubMed.

Overview of epidemiology of depression and anxiety in coronary artery disease

Many studies conducted over the last 10 years have documented that the prevalence of depression is increased among patients with various manifestations of CAD, including those recently hospitalized for an acute myocardial infarction (AMI) 7, 8, unstable angina [9], congestive heart failure [10], and coronary catheterization or angioplasty 11, 12. There is also evidence of an increased prevalence in patients with stable coronary artery disease [13], and at 6 months and 1 year after an AMI [14].

Depression and anxiety before and after bypass surgery

In contrast to the large number of studies documenting relationships between depression and anxiety and cardiovascular disease outcomes, relatively few studies have examined links between psychological symptoms and morbidity and mortality after CABG. Although there is some evidence that surgery may be associated with better psychological and social outcomes after AMI than nonsurgical treatment [25], symptoms of anxiety, depression, or reactive stress are commonly reported among patients with a

Pathophysiology

The factors that link major depression or depressive symptoms, and possibly anxiety, to an increased risk of postsurgical morbidity and mortality remain unclear. In addition to the pathophysiological disturbances postulated to underlie relationships between depression and anxiety and prognosis in CAD patients, several factors specific to cardiac surgery may be involved in CABG patients.

According to several reviews of the current data, symptoms of depression, and to some extent anxiety, may

Interventions before surgery

Evaluation and psychological support specifically designed to reduce the apprehension and emotional tension experienced by CAD patients before cardiac surgery may prevent adverse effects, thus facilitating postoperative recovery and reducing the cost of care [64]. Given that symptoms of anxiety and depression are common in patients scheduled for CABG [26] and can influence the outcome of the procedure, detection of these symptoms during the preoperative evaluation is essential. Structured

Comment

Depression and anxiety are well-recognized cardiovascular risk factors, similar in importance to smoking and hypertension, and must be detected and treated. These psychological disorders can affect the outcomes of cardiovascular disease by numerous pathophysiological mechanisms.

Furthermore, recent studies have confirmed that symptoms of depression or anxiety are associated with worse outcomes after CABG, often with a marked alteration in quality of life. Careful routine evaluation of these

Acknowledgements

We are greatly thankful to Luce Bégin for the preparation of the manuscript.

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