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Published on: March 27, 2018
Depression is associated with increased mortality 10 years after coronary artery bypass surgery
Ingrid Connerney1, Richard P Sloan, Peter A Shapiro
1Division of Quality and Safety, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. iconnerney@umm.edu
Insights
Major depressive disorder (MDD) independently predicts cardiac mortality up to 10 years after coronary artery bypass graft (CABG) surgery. Elevated depressive symptoms, measured by the Beck Depression Inventory (BDI), also indicated increased cardiac death risk in CABG patients.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for cardiovascular disease.
- The long-term impact of depression on mortality after CABG surgery is not well understood.
- Previous research has focused on depression's link to mortality after myocardial infarction.
Purpose of the Study:
- To investigate the independent association between depression and cardiac mortality 10 years post-CABG.
- To examine the relationship between depression and all-cause mortality after CABG surgery.
- To identify predictors of long-term mortality in patients following CABG.
Main Methods:
- A prospective study involving 309 patients hospitalized after CABG surgery.
- Depression assessment using the Diagnostic Interview Schedule and Beck Depression Inventory (BDI) before discharge.
- Mortality data collected via the National Center for Health Statistics and phone interviews for up to 11.5 years.
Main Results:
- 20% of patients met criteria for major depressive disorder (MDD); 28% had elevated depressive symptoms (BDI ≥10).
- MDD was an independent predictor of cardiac mortality (HR, 1.8; p = .04), along with age and left ventricular ejection fraction.
- While age, ejection fraction, and diabetes predicted all-cause mortality, MDD did not.
Conclusions:
- Depression, identified through structured interviews and BDI scores, is significantly linked to increased cardiac mortality 10 years after CABG.
- These findings highlight the importance of addressing depression in post-CABG patient care.
- Depression assessment and management may improve long-term cardiac outcomes in CABG survivors.
Objective:
To determine if depression is independently associated with cardiac and all-cause mortality 10 years after coronary artery bypass graft (CABG) surgery. Although many studies have examined the relationship of depression and mortality in patients with myocardial infarction, there is less understanding of the relationship between depression and long-term mortality after CABG surgery.
Methods:
In a prospective study, we collected data on 309 patients hospitalized after CABG surgery. Before discharge, patients were assessed for depression using the Diagnostic Interview Schedule and the Beck Depression Inventory (BDI). Subsequently, mortality data were obtained from the National Center for Health Statistics and supplemented with phone interviews.
Results:
Sixty-three (20%) patients met modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depressive disorder (MDD) and 87 (28%) had BDI scores of ≥10, indicating elevated depressive symptoms. Time-to-event or last follow-up phone contact ranged from 9 days to 11.5 years (median, 9.3 years). The overall mortality rate was 37.9% (117 of 309), with 20.1% (62 of 309) due to cardiac causes. Cox proportional hazard modeling showed that age (hazard ratio [HR], 1.04; p = .005), left ventricular ejection fraction (EF) (EF <0.35 [HR], 3.9; p < .001; EF, 0.35-0.49 [HR], 1.9; p = .03), and MDD (HR, 1.8; p = .04) were independent predictors of cardiac mortality. The BDI and the cognitive-affective symptoms subset of BDI symptoms were also predictors of cardiac mortality. Age, EF, and diabetes predicted all-cause mortality, but MDD did not.
Conclusions:
Depression, assessed both in structured interview and by BDI, was significantly associated with elevated cardiac mortality 10 years after CABG surgery.
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