Psychosocial and medical predictors of 14-year mortality and morbidity in male and female coronary artery bypass graft recipients: a prospective observational study

Abstract

Background Psychosocial factors may influence mortality and morbidity after coronary bypass surgery (CABG), but it is unclear when, post-surgery, they best predict the outcome, if they interact, or whether results differ for men and women. Methods This prospective, observational study assessed depression symptoms, social support, marital status, household responsibility, functional impairment, mortality and need for further coronary procedures over 14 years of follow-up. Data were collected in-hospital post-CABG and at home 1-year later. Mortality and subsequent cardiac procedure data were extracted from a Cardiac Registry. Results Of 296 baseline participants, 78% (43% were women) completed data at 1-year post-CABG. Long-term survival was shorter with 1-year depression and lower household responsibility but that was not true for the measures taken at baseline [HR for depression = 1.27; 95% CI 1.02–1.59 v. 0.99 (0.78–1.25), and HR = 0.71; 95% CI 0.52–0.97 v. 0.97 (0.80–1.16)] for household responsibility. An interaction between depression symptoms and social support at year 1 [χ2 (11) = 111.05, p < 0.001] revealed a greater hazard of mortality d with increased depression only at mean (HR = 1.67; 95% CI 1.21–2.26) and high social support (HR = 2.23; 95% CI 1.46–3.40). Depression also accounted for increased event recurrence. There were no significant interactions of sex with medical long-term outcomes. Conclusions In a sex-balanced sample, depression and household responsibility measured at 1-year post-CABG were associated with significant variance in unadjusted and adjusted predictor models of long-term mortality whereas the same indices determined right after the procedure were not significant predictors.

Predictors of Psychological Distress among Post-Operative Cardiac Patients: A Narrative Review

“…Moreover, for social interactions (e.g., talking to friends, relatives and others face-to-face), 48% of participants reported a similar degree of interaction both before and after their operation, whilst 28% reported an increase and 24% reported a decrease. Further studies have corroborated this trend for stable or increasing social engagement after cardiac operations (Linden et al [45] and Nielsen et al [46]) with these interactions occurring through participation in religious organisations, community groups, and close relationship circles.…”

“…Female patients self-report greater severity of chronic pain, physical impairment, and long-term post-CABGS pain [43,44]. Since pain and physical impairment are known risk factors for distress among cardiac patients, it is likely that females might be at greater risk of future distress [45]. Furthermore, females appear generally more likely to report distress in the population.…”