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

Abstract

BackgroundPsychosocial 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.MethodsAfter 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.ResultsDuring a median follow-up of 7.6 years (25th to 75th 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.ConclusionsOur 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.

Ansiedade no período pré-operatório de cirurgia cardíaca

“…This instrument is a protocol of free use worldwide used both in research and in clinics to assess the levels of anxiety of patients undergoing a surgical experience. It consists of 21 items, with response alternatives ranging from nothing to mild, moderate, and severe, about which each subject reflects on the gradational levels of each symptom, being anxiety rated in minimal (0-10), mild (11)(12)(13)(14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and severe (31-63) (9) .…”

Short and Long Term Effects of Psychosocial Factors on the Outcome of Coronary Artery Bypass Surgery

“…Patients with less education had a worse life expectancy. There was no significant difference between patients with 9 to 12 years of education and those with an academic degree [13]. Patients with a high level of education are likely to have a higher income and therefore can afford the more expensive "healthy" diet and sport activities [70].…”

“…In multivariable analyses more than twofold increase in readmission risk was associated with preoperative anxiety and postoperative depression, independent of covariates [12]. When our work group investigated the relation-ship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery, we found that there was a significant difference in depression (measured with Beck Depression Inventory (BDI)) between survivors and non survivors preoperatively, after discharge and in both intervals ( Figure 1) [13].…”

“…Our results have suggested 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 ( Figure 2.) [13]. Anxiety was also reported to be associated with twofold risk for fatal CHD and more than fourfold risk for sudden death [28].…”

“…Somatic manifestations are tachycardia, hyperventilation, sweating, psychological manifestations are feelings of apprehension, nervousness, restlessness, and may also cause changes in sleeping pattern [13].…”