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