Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery

Abstract

Background-Depression is an established independent prognostic factor for mortality, readmission, and cardiac events after CABG surgery. However, limited data exist on whether depression influences functional outcomes after CABG. Methods and Results-We followed 963 patients who underwent first CABG between February 1999 and February 2001. At baseline and at 6 months after CABG, we interviewed patients to assess depressive symptoms using the Geriatric Depression Scale (GDS) and physical function using the Short Form-36 Physical Component Scale (PCS). The patient's physical function was considered improved if the PCS score increased Ն5 points at 6 months. Patients with high GDS scores were younger, were more often female, and had worse physical function and higher comorbidity than patients with low GDS scores. Rates of improvement in physical function were 60.1% for a GDS score Ͻ5 (below 75th percentile), 49.8% for a GDS score between 5 and 9 (75th to 90th percentile), and 39.7% for a GDS score Ն10 (Ն90th percentile; Pϭ0.002 for the trend). Depressive symptoms remained a significant independent predictor of lack of functional improvement after adjustment for severity of coronary artery disease, angina class, baseline PCS score, and medical history. A GDS score Ն10 was a stronger inverse risk factor for functional improvement after CABG than such traditional measures of disease severity as previous myocardial infarction, heart failure on admission, history of diabetes, and left ventricular ejection fraction. Conclusions-Higher levels of depressive symptoms at the time of CABG are a strong risk factor for lack of functional benefits 6 months after CABG.

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

“…The latter is important because ~25% of CVD events are associated with PSS, which has been independently shown to be associated with prolonged hospitalization, delayed return to work, and heightened mortality. 99,100 The effects of PSS appear to be cumulative, and are inversely related to HRQoL. 101 In studies that have evaluated major dimensions of HRQoL on post-MI and post-CABG patients using disease-specific and general outcome measures, CR has been reported to enhance PSS profiles, and HRQoL scores.…”

Depression and cardiovascular disease

“…In this issue of Circulation, Mallik et al 4 add to our understanding of the relationship between depression and outcome in cardiac patients. Prospectively evaluating 963 coronary artery bypass graft (CABG) surgery patients, they found that 25% had substantial perioperative depressive symptoms.…”

Untreated preoperative depression is not associated with postoperative arrhythmias in CABG patients

“…[14][15][16][17] Arrhythmia occurs frequently in patients with depression, irrespective of the presence of coronary artery disease. [18][19][20][21][22][23] One of the plausible mechanisms explaining the relationship between depression and arrhythmia is autonomic dysfunction. Patients with depression have altered secretion of norepinephrine, a higher resting heart rate, low heart rate variability, and reduced baroreflex sensitivity, [23][24][25][26][27][28][29] resulting in resting sinus tachycardia.…”