Elsevier

International Journal of Cardiology

Volume 222, 1 November 2016, Pages 462-466
International Journal of Cardiology

Association between preoperative depression and long-term survival following coronary artery bypass surgery — A systematic review and meta-analysis

https://doi.org/10.1016/j.ijcard.2016.07.216Get rights and content

Abstract

Background

Depression is common in patients with cardiovascular disease. The importance of preoperative depression for long-term survival following coronary artery bypass grafting (CABG) is not well known. The aim was to provide a summary estimate of the association between preoperative depression and long-term survival in adults who underwent CABG.

Methods

We did a systematic search of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, and PubMed from inception to November, 2015, including cohort studies with at least one month of follow-up that reported hazard ratios (HR) and 95% confidence intervals (CI) for long-term all-cause mortality following CABG in patients with preoperative depression compared to non-depressed patients. Two reviewers independently extracted data on populations, exposure, outcome, risk of bias, and quality of evidence. We calculated HR and 95% CIs for all-cause mortality using random-effects meta-analyses and performed subgroup and sensitivity analyses.

Results

Seven studies were included with a combined study population of 89,490 patients (4002 depressed/85,488 non-depressed). All studies observed a positive association between preoperative depression and all-cause mortality, and in 4 studies the association was statistically significant. Patients with depression had a pooled hazard ratio of 1.46 (95% CI: 1.23–1.73, p < 0.0001) for all-cause mortality with moderate heterogeneity (I2 = 50.1%, p = 0.061).

Conclusions

This systematic review and meta-analysis indicates that patients with preoperative depression are at increased risk for long-term, all-cause mortality following CABG compared with those without depression. Systematic screening for depression prior to cardiac surgery could identify those at higher risk.

Introduction

The rate of major depressive disorder is 2- to 3-fold higher in patients with cardiovascular disease (CVD) than among the general population [1]. Perioperative complications, risk for rehospitalization and mortality is also increased in patients with depression who undergo coronary artery bypass grafting (CABG) compared with patients without depression [2], [3], [4], [5]. Depressive symptoms have been associated with the development and progression of coronary heart disease and a 2–2,5-fold increased risk of mortality [1]. In many patients depression has existed for months or years before a cardiac event rather than being a reaction to the event [6]. Previously published reviews have focused on the high rate of comorbid depression and CVD, and the effect of depression on prognosis in patients with CVD [1]. [7] This is the first systematic review and meta-analysis that investigates the association between preoperative depression and long-term survival after CABG.

Section snippets

Study design

A systematic literature review and meta-analysis was performed following an a priori established study protocol.

Search strategy and selection criteria

References for this systematic review – depression and cardiac surgery – were searched without language or year restrictions in the following databases: (OVID®), Embase® (Elsevier), Cochrane Library including CENTRAL (Wiley), PsycINFO® (OVID®), Web of Science™ Core Collection (Thomson Reuters), PubMed (complementary search of non-indexed material).

Two librarians at the Karolinska

Results

The literature search was finalised on November 17 2015. A total of 1357 unique records were identified through the literature search. Of these, 1209 were excluded due to title or abstract content, 80 due to wrong population or outcome and 24 were review articles. The remaining 44 full-text articles were assessed for eligibility and 7 studies met the inclusion criteria [14], [15], [16], [17], [18], [19], [20] (Fig. 1). Studies included in the meta-analysis were published between 2003 and 2015,

Discussion

This systematic review and meta-analysis found a statistically significant association between preoperative depression and worse long-term survival following CABG. In the subgroup analysis it was found that patients with depression defined from depression questionnaires had an increased risk for mortality, but this was not statistically significant. The reason for the non-significant result was most likely the lower number of patients in this subgroup. In the analysis with antidepressant use as

Conclusion

This review summarises the findings of the relationship between preoperative depression and long-term survival following CABG and discusses the mechanisms that could potentially explain this relationship. This systematic review and meta-analysis indicates that depression is a significant risk factor for worse long-term survival following CABG.

Disclosures

None.

Grant support

This study was supported by grants from the Swedish Heart-Lung Foundation (M.S. and U.S.), Capio Research Foundation (M.S), and the Mats Kleberg Foundation (U.S.). The funding sources had no involvement in the conduct of the research or the preparation of the article.

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Acknowledgements

The authors thank Klas Moberg and Magdalena Svanberg, Karolinska Institutet University Library, for excellent help with the systematic literature search. There was no compensation for their contribution.

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