Cardiac morbidity risk and depression and anxiety: A disorder, symptom and trait analysis among cardiac surgery patients

Abstract

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.

Selective Serotonin Reuptake Inhibitors, Venlafaxine and Duloxetine are Associated With in Hospital Morbidity but Not Bleeding or Late Mortality After Coronary Artery Bypass Graft Surgery

“…Likewise, the SSRI/SNRI group was characterised by preponderance to CVD, diabetes, hypertension and female sex, all covariates potentially increasing the risk of morbidity and mortality [19]. As such, these findings reflect an association and not causality, and it cannot be ruled out that the association between anti-depressants and morbidity may alternatively reflect an acute distressed state [42] and not the SSRI/SNRI use per se. Lastly, the infrequent rate of some postoperative morbidity events and the low-rate of SSRI/SNRI use was reflected in the width of the confidence intervals, suggesting these findings should be interpreted cautiously.…”

“…The estimated prevalence of unipolar depression in Australian CABG surgery patients is generally reported at 15-20%[41,42], suggesting a disparity…”

Embracement and anxiety symptoms in patients before cardiac surgery

“…Em estudo prévio observou-se que a ansiedade no pré-operatório, estava presente em torno de 80% dos pacientes adultos que aguardavam cirurgias (4) . Frente a isso, a ansiedade merece a devida atenção da equipe de saúde, pois pode influenciar na resposta do paciente ao tratamento e causar efeitos negativos em sua recuperação pós-operatória (5)(6) . Além do mais, a ansiedade acarreta alterações fisiológicas, como taquicardia e hipertensão arterial, com consequente aumento do consumo de oxigênio e piora da evolução da doença (6)(7) .…”

Importance of psychosocial status in secondary prevention and rehabilitation of coronary artery disease

“…[18][19][20] There are however studies that have failed to find such negative outcomes. 21,22 Another area of similarity of anxiety to depression relates to compliance with cardiac rehabilitation. As with depression, anxiety is implicated in poor completion rates and higher drop-out rates in rehabilitation, 22,23 but it also appears to be indicative of the likelihood of readmission 24 as well as the number of readmissions.…”