Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review

Phillip J Tully, Robert A Baker, Phillip J Tully, Robert A Baker

Abstract

Research to date indicates that the number of coronary artery bypass graft (CABG) surgery patients affected by depression (i.e., major, minor, dysthymia) approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsychological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.

Keywords: Antidepressive agents; Anxiety; Coronary artery bypass; Coronary artery disease; Depression; Depressive disorder.

References

    1. Taggart DP, Thomas B. Ferguson lecture. Coronary artery bypass grafting is still the best treatment for multivessel and left main disease, but patients need to know. Ann Thorac Surg. 2006;82:1966–1975.
    1. Connerney I, Shapiro PA, McLaughlin JS, et al. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet. 2001;358:1766–1771.
    1. Tully PJ, Baker RA, Winefield HR, et al. Depression, anxiety disorders and Type D personality as risk factors for delirium after cardiac surgery. Aust N Z J Psychiatry. 2010;44:1005–1011.
    1. Fraguas JR, Ramadan ZB, Pereira AN, et al. Depression with irritability in patients undergoing coronary artery bypass graft surgery: the cardiologist's role. Gen Hosp Psychiatry. 2000;22:365–374.
    1. Rafanelli C, Roncuzzi R, Milaneschi Y. Minor depression as a cardiac risk factor after coronary artery bypass surgery. Psychosomatics. 2006;47:289–295.
    1. Mitchell RH, Robertson E, Harvey PJ, et al. Sex differences in depression after coronary artery bypass graft surgery. Am Heart J. 2005;150:1017–1025.
    1. Gehi A, Haas D, Pipkin S, et al. Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med. 2005;165:2508–2513.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th Edition. Amer Psychiatric Pub; Washington DC, USA: 2000.
    1. Fraguas R, Jr, Iosifescu DV, Alpert J, et al. Major depressive disorder and comorbid cardiac disease: is there a depressive subtype with greater cardiovascular morbidity? Results from the STAR*D study. Psychosomatics. 2007;48:418–425.
    1. Kazmierski J, Kowman M, Banach M, et al. Preoperative predictors of delirium after cardiac surgery: a preliminary study. Gen Hosp Psychiatry. 2006;28:536–538.
    1. Rothenhausler HB, Grieser B, Nollert G, et al. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry. 2005;27:18–28.
    1. Tully PJ, Baker RA, Turnbull D, et al. The role of depression and anxiety symptoms and hospital readmissions after cardiac surgery. J Behav Med. 2008;31:281–290.
    1. Baker RA, Andrew MJ, Schrader G, et al. Preoperative depression and mortality in coronary artery bypass surgery: Preliminary findings. ANZ J Surg. 2001;71:139–142.
    1. Borowicz L, Jr, Royall R, Grega M, et al. Depression and cardiac morbidity 5 years after coronary artery bypass surgery. Psychosomatics. 2002;43:464–471.
    1. McKhann GM, Borowicz LM, Goldsborough MA, et al. Depression and cognitive decline after coronary artery bypass grafting. The Lancet. 1997;349:1282–1284.
    1. Peterson JC, Charlson ME, Williams-Russo P, et al. New postoperative depressive symptoms and long-term cardiac outcomes after coronary artery bypass surgery. Am J Geriatr Psychiatry. 2002;10:192–198.
    1. Koivula M, Tarkka MT, Tarkka M, et al. Fear and anxiety in patients at different time-points in the coronary artery bypass process. Int J Nurs Stud. 2002;39:811–822.
    1. Fitzsimons D, Parahoo K, Richardson SG, et al. Patient anxiety while on a waiting list for coronary artery bypass surgery: a qualitative and quantitative analysis. Heart Lung. 2003;32:23–31.
    1. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2004;44:E213–E310.
    1. Krannich JH, Weyers P, Lueger S, et al. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry. 2007;12:47.
    1. Andrew MJ, Baker RA, Kneebone AC, et al. Mood state as a predictor of neuropsychological deficits following cardiac surgery. J Psychosom Res. 2000;48:537–546.
    1. Bunker SJ, Colquhoun DM, Esler MD, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust. 2003;178:272–276.
    1. Tully PJ, Pedersen SS, Winefield HR, et al. Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients. Psychol Health Med. 2011;16:333–345.
    1. Chen YH, Tsai SY, Lee HC, et al. Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study. Psychosom Med. 2009;71:798–804.
    1. Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry. 2008;65:62–71.
    1. Dao TK, Chu D, Springer J, et al. Clinical depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder as risk factors for in-hospital mortality after coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg. 2010;140:606–610.
    1. Schelling G, Richter M, Roozendaal B, et al. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med. 2003;31:1971–1980.
    1. Schreiber S, Soskolne V, Kozohovitch H, et al. Holocaust survivors coping with open heart surgery decades later: posttraumatic symptoms and quality of life. Gen Hosp Psychiatry. 2004;26:443–452.
    1. Feinstein RE, Blumenfield M, Orlowski B, et al. A national survey of cardiovascular physicians' beliefs and clinical care practices when diagnosing and treating depression in patients with cardiovascular disease. Cardiol Rev. 2006;14:164–169.
    1. Charlson ME, Isom OW. Clinical practice. Care after coronary- artery bypass surgery. N Engl J Med. 2003;348:1456–1463.
    1. Smith SC, Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58:2432–2446.
    1. Lichtman JH, Bigger JT, Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008;118:1768–1775.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–1744.
    1. Carney R, Freedland K. Is there a high-risk subtype of depression in patients with coronary heart disease? Curr Psychiatry Rep. 2012;14:1–7.
    1. Shemesh E, Annunziato RA, Rubinstein D, et al. Screening for depression and suicidality in patients with cardiovascular illnesses. Am J Cardiol. 2009;104:1194–1197.
    1. Koenig HG, George LK, Peterson BL, et al. Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes. Am J Psychiatry. 1997;154:1376–1383.
    1. Contrada RJ, Boulifard DA, Idler EL, et al. Course of depressive symptoms in patients undergoing heart surgery: confirmatory analysis of the factor pattern and latent mean structure of the Center for Epidemiologic Studies Depression Scale. Psychosom Med. 2006;68:922–930.
    1. The MacArthur Initiative on Depression in Primary Care, Use of the PHQ-9 to make a tentative diagnosis (symptomatology and functional impairment), 2011. (Access on May 28, 2012).
    1. Tully PJ, Penninx BW. Depression and anxiety among coronary heart disease patients: can affect dimensions and theory inform diagnostic disorder based screening? J Clin Psychol. 2012;68:448–461.
    1. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–1097.
    1. Kroenke K, Spitzer RL, Williams JB, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345–359.
    1. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146538 participants in 54 observational studies. Eur Heart J. 2006;27:2763–2774.
    1. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005;131:260–300.
    1. Blumenthal JA, Lett HS, Babyak MA, et al. Depression as a risk factor for mortality after coronary artery bypass surgery. The Lancet. 2003;362:604–609.
    1. Burg MM, Benedetto MC, Rosenberg R. Presurgical depression predicts medical morbidity 6 months after coronary artery bypass graft surgery. Psychosom Med. 2003;65:111–118.
    1. Oxlad M, Stubberfield J, Stuklis R, et al. Psychological risk factors for cardiac-related hospital readmission within 6 months of coronary artery bypass graft surgery. J Psychosom Res. 2006;61:775–781.
    1. Saur CD, Granger BB, Muhlbaier LH, et al. Depressive symptoms and outcome of coronary artery bypass grafting. Am J Crit Care. 2001;10:4–10.
    1. Connerney I, Sloan RP, Shapiro PA, et al. Depression is associated with increased mortality 10 years after coronary artery bypass surgery. Psychosom Med. 2010;72:874–881.
    1. Tully PJ, Baker RA, Turnbull DA, et al. Negative emotions and quality of life six months after cardiac surgery: the dominant role of depression not anxiety symptoms. J Behav Med. 2009;32:510–522.
    1. Scheier MF, Matthews KA, Owens JF, et al. Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med. 1999;159:829–835.
    1. Mallik S, Krumholz HM, Lin ZQ, et al. Patients with depressive symptoms have lower health status benefits after coronary artery bypass surgery. Circulation. 2005;111:271–277.
    1. Tully PJ, Winefield HR, Baker RA, et al. Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization. J Health Psychol. 2011;16:584–595.
    1. Tully PJ, Baker RA, Knight JL. Anxiety and depression as risk factors for mortality after coronary artery bypass surgery. J Psychosom Res. 2008;64:285–290.
    1. Tully PJ, Bennetts JS, Baker RA, et al. Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgery. Heart Lung. 2011;40:4–11.
    1. Burg MM, Benedetto MC, Soufer R. Depressive symptoms and mortality two years after coronary artery bypass graft surgery (CABG) in men. Psychosom Med. 2003;65:508–510.
    1. Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 1--Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg. 2009;88(1 Suppl):S2–S22.
    1. Sockalingam S, Parekh N, Bogoch II, et al. Delirium in the postoperative cardiac patient: a review. J Card Surg. 2005;20:560–567.
    1. Leentjens AF, Maclullich AM, Meagher DJ. Delirium, Cinderella no more...? J Psychosom Res. 2008;65:205.
    1. Norkiene I, Ringaitiene D, Misiuriene I, et al. Incidence and precipitating factors of delirium after coronary artery bypass grafting. Scand Cardiovasc J. 2007;41:180–185.
    1. Rolfson DB, McElhaney JE, Rockwood K, et al. Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. Can J Cardiol. 1999;15:771–776.
    1. Rudolph JL, Babikian VL, Birjiniuk V, et al. Atherosclerosis is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc. 2005;53:462–466.
    1. Rudolph JL, Jones RN, Grande LJ, et al. Impaired executive function is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc. 2006;54:937–941.
    1. Santos FS, Velasco IT, Fraguas R., Jr Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr. 2004;16:175–193.
    1. Yoon BW, Bae HJ, Kang DW, et al. Intracranial cerebral artery disease as a risk factor for central nervous system complications of coronary artery bypass graft surgery. Stroke. 2001;32:94–99.
    1. McAvay GJ, Van Ness PH, Bogardus ST, Jr, et al. Depressive symptoms and the risk of incident delirium in older hospitalized adults. J Am Geriatr. 2007;55:684–691.
    1. Davydow DS. Symptoms of depression and anxiety after delirium. Psychosomatics. 2009;50:309–316.
    1. Rudolph JL, Schreiber KA, Culley DJ, et al. Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010;54:663–677.
    1. Tully PJ, Baker RA, Kneebone AC, et al. Neuropsychologic and quality of life outcomes following coronary artery bypass surgery with and without cardiopulmonary bypass: a prospective randomized trial. J Cardiothorac Vasc Anesth. 2008;22:515–521.
    1. Tully PJ, Baker RA, Knight JL, et al. Neuropsychological function five years after cardiac surgery and the effect of psychological distress. Arch Clin Neuropsychol. 2009;24:741–751.
    1. Barger SD, Sydeman SJ. Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord. 2005;88:87–91.
    1. Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med. 2003;36:698–703.
    1. Carney RM, Freedland KE, Eisen SA, et al. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol. 1995;14:88–90.
    1. Kuhl EA, Fauerbach JA, Bush DE, et al. Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction. Am J Cardiol. 2009;103:1629–1634.
    1. Frasure-Smith N, Lesperance F, Irwin MR, et al. Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry. 2007;62:302–308.
    1. Soufer R, Arrighi JA, Burg MM. Brain, behavior, mental stress, and the neurocardiac interaction. J Nucl Cardiol. 2002;9:650–662.
    1. McCaffery JM, Frasure-Smith N, Dube MP, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med. 2006;68:187–200.
    1. Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008;65:229–238.
    1. Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. Am J Med. 2000;108:2–8.
    1. Ha JH, Wong CK. Pharmacologic treatment of depression in patients with myocardial infarction. J Geriatr Cardiol. 2011;8:121–126.
    1. Dowlati Y, Herrmann N, Swardfager WL, et al. Efficacy and tolerability of antidepressants for treatment of depression in coronary artery disease: a meta-analysis. Can J Psychiatry. 2010;55:91–99.
    1. Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288:701–709.
    1. Veien KT, Videbaek L, Schou M, et al. High mortality among heart failure patients treated with antidepressants. Int J Cardiol. 2011;146:64–67.
    1. Von Ruden AE, Adson DE, Kotlyar M. Effect of selective serotonin reuptake inhibitors on cardiovascular morbidity and mortality. J Cardiovasc Pharmacol Ther. 2008;13:32–40.
    1. Tata LJ, West J, Smith C, et al. General population based study of the impact of tricyclic and selective serotonin reuptake inhibitor antidepressants on the risk of acute myocardial infarction. Heart. 2005;91:465–471.
    1. Kim DH, Daskalakis C, Whellan DJ, et al. Safety of selective serotonin reuptake inhibitor in adults undergoing coronary artery bypass grafting. Am J Cardiol. 2009;103:1391–1395.
    1. Andreasen JJ, Riis A, Hjortdal VE, et al. Effect of selective serotonin reuptake inhibitors on requirement for allogeneic red blood cell transfusion following coronary artery bypass surgery. Am J Cardiovasc Drugs. 2006;6:243–250.
    1. Xiong GL, Jiang W, Clare R, et al. Prognosis of patients taking selective serotonin reuptake inhibitors before coronary artery bypass grafting. Am J Cardiol. 2006;98:42–47.
    1. Tully PJ, Cardinal T, Bennetts JS, et al. 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. Heart Lung Circ. 2012;21:206–214.
    1. Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev. 2011;9:CD008012.
    1. Pizzi C, Rutjes AW, Costa GM, et al. Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease. Am J Cardiol. 2011;107:972–979.
    1. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58:2584–2614.
    1. Shuldham CM, Fleming S, Goodman H. The impact of pre- operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial. Eur Heart J. 2002;23:666–674.
    1. Sorlie T, Busund R, Sexton J, et al. Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery-A randomized trial. Patient Educ Couns. 2007;65:180–188.
    1. Arthur HM, Daniels C, McKelvie R, et al. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial. Ann Intern Med. 2000;133:253–262.
    1. Freedland KE, Skala JA, Carney RM, et al. Treatment of depression after coronary artery bypass surgery: a randomized controlled trial. Arch Gen Psychiatry. 2009;66:387–396.
    1. Rollman BL, Belnap BH, LeMenager MS, et al. Telephone- delivered collaborative care for treating post-CABG depression: a randomized controlled trial. JAMA. 2009;302:2095–2103.
    1. Lie I, Arnesen H, Sandvik L, et al. Effects of a home-based intervention program on anxiety and depression 6 months after coronary artery bypass grafting: a randomized controlled trial. J Psychosom Res. 2007;62:411–418.
    1. Sebregts EH, Falger PR, Appels A, et al. Psychological effects of a short behavior modification program in patients with acute myocardial infarction or coronary artery bypass grafting. A randomized controlled trial. J Psychosom Res. 2005;58:417–424.
    1. Hermele S, Olivo EL, Namerow P, et al. Illness representations and psychological distress in patients undergoing coronary artery bypass graft surgery. Psychol Health Med. 2007;12:580–591.
    1. Smith TW, Cundiff JM. Aggregation of psychosocial risk factors: Models and methods. In: Waldstein SR, Kop WJ, Katzel LI, editors. Handbook of cardiovascular behavioral medicine. Springer; New York: 2011.
    1. Oxman TE, Barrett JE, Freeman DH, et al. Frequency and correlates of adjustment disorder related to cardiac surgery in older patients. Psychosomatics. 1994;35:557–568.
    1. Phillips-Bute B, Mathew JP, Blumenthal JA, et al. Relationship of genetic variability and depressive symptoms to adverse events after coronary artery bypass graft surgery. Psychosom Med. 2008;70:953–959.
    1. Szekely A, Balog P, Benko E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery-a 4-year follow-up study. Psychosom Med. 2007;69:625–631.

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