The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery

Journal of Cardiothoracic Surgery

Andrea Székely⁵  János Gál²  Miklós D Kertai²  Boglárka Juhász¹  András Husz²  Tamás Szili-Török¹  Piroska Balog⁴  Eszter Losoncz³  Zsuzsanna Cserép² 

[1] Department of Cardiac Surgery of Gottsegen György Hungarian Institute of Cardiology, Budapest, H-1096, Hungary;Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, H-1085, Hungary;University of Szeged, Szeged, H-6720, Hungary;Institute of Behavioral Sciences, Semmelweis University, Budapest, H-1085, Hungary;Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Haller u. 29, Budapest, H-1096, Hungary

关键词: Education;    Depression;    Anxiety;    Cardiac surgery;    Mortality;   

Others  :  1152919
DOI  :  10.1186/1749-8090-7-86

 received in 2012-02-08, accepted in 2012-09-07,  发布年份 2012

【 摘 要 】

Background

Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery.

Methods

After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths.

Results

During a median follow-up of 7.6 years (25^th to 75^th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained.

Conclusions

Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.

【 授权许可】

   
2012 Cserep et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Hemingway H, Marmot M: Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ 1999, 318(7196):1460-1467.
• [2]Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, Jones R, Mathew JP, Newman MF, NORG Investigators: Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003, 362(9384):604-609.
• [3]Cohn WE: Advances in surgical treatment of acute and chronic coronary artery disease. Tex Heart Inst J 2010, 37(Suppl 3):328-330.
• [4]Székely A, Balog P, Benkö E, Breuer T, Székely J, Kertai MD, Horkay F, Kopp MS, Thayer JF: Anxiety predicts mortality and morbidity after coronary artery and valve surgery-a 4-year follow-up study. Psychosom Med 2007, 69:625-631.
• [5]Brummett BH, Barefoot JC, Siegler IC, Clapp-Channing NE, Lytle BL, Bosworth HB, Williams RB Jr, Mark DB: Characteristics of Socially Isolated Patients With Coronary Artery Disease Who Are at Elevated Risk for Mortality. Psychosom Med 2001, 63:267-272.
• [6]Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S, INTERHEART investigators: Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case–control study. Lancet 2004, 364:953-962.
• [7]Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L: Risk factors and outcome in European cardiac surgery: analysis of the EUROSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999, 15:816-822.
• [8]Ferguson TB Jr, Dziubian SW, Edwards FH: Committee to establish a national database in cardiothoracic surgery. The society of thoracic surgeons. The STS database. Current changes and challenges for the new millennium. Ann Thorac Surg 2000, 69:680-691.
• [9]Beck AT, Steer RA, Brown GK: Beck Depression Inventory-Second Edition Manual. San Antonio: TX: The Psychological Corporation; 1996.
• [10]Shen BJ, Wachowiak PS, Brooks LG: Psychosocial factors and assessment in cardiac rehabilitation. Eura Medicophys 2005, 41:75-91.
• [11]Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 1951, 16(Suppl 3):297-334.
• [12]Spielberger CD, Gorsuch A, Lushane R, Vagg PR, Jacobs GA: Manual for the State-Trait Anxiety Inventory. Palo Alto, California: Consulting Psychologists Press; 1970.
• [13]Babyak MA: What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med 2004, 66:411-421.
• [14]Albus C: Psychological and social factors in coronary heart disease. Ann Med 2010, 42(Suppl 7):487-494.
• [15]Connerney I, Shapiro PA, McLaughlin JS, Bagiella E, Sloan RP: Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001, 358(9295):1766-1771.
• [16]Rosenbloom JI, Wellenius GA, Mukamal KJ, Mittleman MA: Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with Coronary Artery Bypass Grafts (CABG). Am Heart J 2009, 158(Suppl 5):867-873.
• [17]Jiang W, Kuchibhatla M, Cuffe MS, Christopher EJ, Alexander JD, Clary GL, Blazing MA, Gaulden LH, Califf RM, Krishnan RR, O'Connor CM: Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation 2004, 110(Suppl 22):3452-3456.
• [18]Phillips-Bute B, Mathew JP, Blumenthal JA, Morris RW, Podgoreanu MV, Smith M, Stafford-Smith M, Grocott HP, Schwinn DA, Newman MF, Perioperative Genetics and Safety Outcomes Investigative Team: Perioperative Genetics and Safety Outcomes Investigative Team. Relationship of genetic variability and depressive symptoms to adverse events after coronary artery bypass graft surgery. Psychosom Med 2008, 70(9):953-959.
• [19]Rutledge T, Linke SE, Johnson BD, Bittner V, Krantz DS, Cornell CE, Vaccarino V, Pepine CJ, Handberg EM, Eteiba W, Shaw LJ, Parashar S, Eastwood JA, Vido DA, Merz CN: Relationships between cardiovascular disease risk factors and depressive symptoms as predictors of cardiovascular disease events in women. J Womens Health (Larchmt) 2012, 21(2):133-139.
• [20]Tully PJ, Baker RA, Knight JL: Anxiety and depression as risk factors for mortality after coronary artery bypass surgery. J Psychosom Res 2008, 64:285-290.
• [21]Kustrzycki W, Rymaszewska J, Malcher K, Szczepanska-Gieracha J, Biecek P: Risk factors of depressive and anxiety symptoms 8 years after coronary artery bypass grafting. Eur J Cardiothorac Surg 2012, 41(2):302-306.
• [22]Frasure-Smith N, Lespérance F: Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 2008, 65(Suppl 1):62-71.
• [23]Kopp M, Skrabski A, Szántó Z, Siegrist J: Psychosocial determinants of premature cardiovascular mortality differences within Hungary. J Epidemiol Community Health 2006, 60:782-788.
• [24]Gerber Y, Goldbourt U, Drory Y, Israel Study Group on First Acute Myocardial Infarction: Interaction between income and education in predicting long-term survival after acute myocardial infarction. Eur J Cardiovasc Prev Rehabil 2008, 15:526-532.
• [25]Jenkins CD, Jono RT, Stanton BA: Predicting completeness of symptom relief after major heart surgery. Behav Med 1996, 22(Suppl 2):45-57.
• [26]Thombs BD, de Jonge P, Coyne JC, Whooley MA, Frasure-Smith N, Mitchell AJ, Zuidersma M, Eze-Nliam C, Lima BB, Smith CG, Soderlund K, Ziegelstein RC: Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA 2008, 300(18):2161-2171.