ArticlesRelation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study
Introduction
Coronary artery bypass graft (CABG) surgery is the most widely used surgical procedure for relief of symptoms of coronary artery disease. Although some adverse outcomes of such surgery can be attributed to physical factors, the great variation of outcomes remains unexplained. Results of prospective community studies1, 2, 3 have shown that depression affects mortality from cardiac events. Depression after myocardial infarction or cardiac catheterisation raises the risk of cardiac events by a factor of two to four, independently of standard severity-of-illness variables,4, 5, 6, 7 and is an important predictor of cardiac mortality at 6, 12, and 18 months,6, 8, 9 and at 5–10 year follow-up.5, 10
Prevalence of depression before or after CABG surgery is about 20–25%.11, 12 Scheier and colleagues13 showed that patients with significant depressive symptoms had almost two-fold increased odds of having a cardiac event in the first 6 months after surgery. However, they did not assess the presence of major depressive disorder, which in myocardial infarction has been associated with greater than three-fold increased 6-month mortality after adjustment for other risk factors.
We have examined the association between depression and cardiac and non-cardiac events in the 12 months after CABG surgery. We measured depression with a structured interview while patients were in hospital after surgery. We also looked at whether sex and depression interacted to affect outcomes.
Section snippets
Patients
The sample consisted of 366 consecutive patients who had had CABG surgery at the University of Maryland Medical Center between March and November, 1997. We excluded two (0·5%) patients because they had insufficient knowledge of English, and 16 (4%) were too ill to complete the study interview before discharge. There were no eligibility restrictions for ejection fraction, age, or urgency of surgery. Of the 348 eligible patients, 309 (89%) gave written informed consent (approved by the
Results
The mean age of the 309 patients included in the study was 63·1 years (SD 10·2). Two-thirds were male. Most patients were white (87%) or African-American (12%). Mean ejection fraction was 0·48 (SD 0·13). Of the 309 patients, over half had an ejection fraction of 0·50 or greater, just under a third between 0·35 and 0·49, and the remainder less than 0·35 (severe dysfunction of the heart) (table 1). Four patients were lost to follow-up at 2 (one) and 6 (three) months and were censored in the Cox
Discussion
An advantage of our study was that we used a structured psychiatric interview to assess major depression and its relation to cardiac events after CABG surgery. Patients who met modified DSM-IV criteria for major depression in the hospital were more than twice as likely to die or be readmitted for cardiac causes in the 12 months after discharge from the hospital than those without this disorder. Major depressive disorder increased the frequency of cardiac events independently of usual risk
References (30)
In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men
Am J Cardiol
(1991)- et al.
Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction
Lancet
(1994) - et al.
Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS)
Am J Cardiol
(1990) - et al.
Personality as independent predictor of long-term mortality in patients with coronary heart disease
Lancet
(1996) - et al.
Depression and cognitive decline after coronary artery bypass grafting
Lancet
(1997) - et al.
Psychosometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clin Psychol Rev
(1988) - et al.
Association of depression with reduced heart rate variability in coronary artery disease
Am J Cardiol
(1995) - et al.
Depression and bipolar disorder: relationships to impaired fatty acid and phospholipid metabolism and to diabetes, cardiovascular disease, immunological abnormalities, cancer, ageing and osteoporosis: possible candidate genes
Prostaglandins Leukot Essent Fatty Acids
(1999) - et al.
Comparison of the long-term, postsurgical survival of women and men in the Coronary Artery Surgery Study (CASS)
Am Heart J
(1989) - et al.
Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS)
J Thorac Cardiovasc Surg
(1982)
A prospective evaluation of the pyschosocial effects of coronary artery bypass surgery
J Psychosom Res
Symptoms of depression, acute myocardial infarction, and total mortality in a community sample
Circulation
Depressed effect, hopelessness, and the risk of ischemic heart disease in a cohort of US adults
Epidemiology
Depression and cardiovascular diseases
Acta Psychiatr Scand Suppl
Major depressive disorder predicts cardiac events in patients with coronary artery disease
Psychosom Med
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