Table 3.
Association between depression and mortality or cardiac outcome after cardiac surgery.
| Reference | Sample | Age (% female) | Follow-up | Outcome, N (%) | Depression Measures | Prevalence Preoperative/Postoperative | Adjustment | Critical Value HR/OR/RR (95% CI) |
|---|---|---|---|---|---|---|---|---|
| Baker (9) | 158 CAO ± valve, AUS | 64.6 (25.3) | Median 2 years | All-cause mortality, n = 6 (3.8) | DASS ≥ 10 | 1 day preoperative, 15.2% | — | Unadjusted OR 6.24; 95% CI = 1.18–32.98, p < .05 |
| Blumenthal (24) | 817 CAG, US | 61 (27) | Mean 5.2 years | All-cause mortality, n = 122 (15) | CES-D 16–26 (mild) | 1 day preoperative, 26.1% mild preoperative | Cigarette smoking, LVEF, sex, age, grafts 4 vs 2, DM, previous MI, | Moderate-severe adjusted HR 2.37 (1.40–4.00), p = .001; |
| CES-D ≥ 27 (moderate to severe) | 11.9% moderate to severe preoperative, | mild adjusted HR 1.08 (.70–1.67), p = .723 | ||||||
| Burg (33) | 89 CAG, US | 66.3 (0) | 2 years | Cardiovascular mortality, n = 5 (5.6) | BDI ≥ 10 | <1 week preoperative 28.1% | Tu score (age, gender, LV function, urgency, redo) | Adjusted OR = 23.16 (95% CI = 1.38–389.08, p = . 03 |
| Burg (25) | 89 CAG, US | 65.9 (0) | 6 months | Hospitalization for MI or unstable angina, n = 8 (9) | BDI ≥ 10 | <1 week 28.1% preoperative | History of MI, chronic renal insufficiency | χ2 = 4.24, p = . 039 |
| Connerney (4) | 309 CAG, US | 63.1 (33) | 12 months | MI, PCTA, redo, cardiac arrest, death resulting from cardiac causes, rehospitalization for angina, CHF, n = 42 (14) | BDI ≥ 10 | 4–10 days postoperative, 28% | MDD, LVEF, sex, living alone, LOS, NYHA class, CAG/valve, vessels | Adjusted RR = 1.62 (.83–3.16), p = NR |
| Connerney (4) | 309 CAG, US | 63.1 (33) | 12 months | MI, PCTA, redo, cardiac arrest, death resulting from cardiac causes, rehospitalization for angina, CHF, n = 42 (14) | DIS | 4–10 days postoperative, 20.4% | LVEF, sex, living alone, LOS, NYHA class, CAG/valve, vessels | Adjusted RR 2.31 (1.17–4.56) p = . 01 |
| Connerney (28) | 309 CAG, US | 63.1 (33) | Median 9.3 years | Cardiac mortality, n = 62 (20.1) | DIS | 4–10 days postoperative, 20.4% | Female sex, age, LVEF, DM | Adjusted HR 1.78 (1.04–3.04), p = .04 |
| Connerney (28) | 309 CAG, US | 63.1 (33) | Median 9.3 years | All-cause mortality, n = 117(37.9) | DIS | 4–10 days postoperative, 20.4% | Female sex, age, LVEF, DM | Adjusted HR 1.19 (.78–1.82), p = . 42 |
| Oxlad (26) | 119 CAG ± valve, AUS | 63.3 (16.0) | 6 months | CHD or surgery related readmission, n = 21 (17.9) | DASS-D ≥ 10 | 5–6 days postoperative, 15.7% | CPB time | Adjusted preoperative HR 5.15 (1.45–18.28), p = . 01 Adjusted postoperative HR = .97 (.25–3.79), p = .96 |
| Oxman (77) | 232 CAG, AVR, CAG ± AVR, US | ¥(28) | 6 months | In-hospital and postoperative all-cause mortality, n = 21 (9.1) | HAM-D ≥ 9 | 1–2 weeks preoperative 21.6% | — | χ2, p = .07 |
| Phillips-Bute (78) | 427 CAG, US | 61 (30) | 2 years | Repeat CAG, PCI, MI, cardiac arrest, all-cause mortality, n = not stated | CES-D >16 | 1 day preoperative 36.8% | None | Unadjusted OR = 2.6; 95% CI = 1.6–4.3, p <. 05 |
| Szekley (79) | 180 CAG/valve, HUN | 57.9 (33.9) | 4 years | All-cause mortality, n = 17 (9.4) | BDI > 10 | 1–5 days preoperative 44% | — | NS, not reported |
| Szekley (79) | 180 CAG/valve, HUN | 57.9 (33.9) | 4 years | Cardiac death, hospitalization for angina, CHF, MI, PTCA, cardiac arrest, n = 48 (26.2) | BDI > 10 | 1–5 days preoperative 44% | DM, postoperative infection, ICU days, preoperative and post discharge 6th month STAI-T, 6 month BDI scores | Adjusted HR = .980 (95% CI = .917–1.047, p = .544) |
| Tully (61) | 440 CAG ± valve, AUS | 64 (20) | Median 5 years 10 months | All-cause mortality, n = 67 (15.2) | DASS-D ≥ 10 | <1 week preoperative 20% | Age, renal disease, valve procedure, CVD, PVD | Adjusted HR = 1.61 (95% CI = .91–2.85), p = .10 |
| Tully (11) | 226 CAG, AUS | 63 (17) | 6 months | Cardiovascular/surgery re admission, n = 72 (32) | DASS-D ≥ 10 | <1 week preoperative 20.1% 4 days postoperative 23.5% | Anxiety, stress, age, sex, LVEF, urgency, lung disease, CHF, DM, PVD, renal disease, MI < 90 days, HTN, CCS, psychoactive medication use | Adjusted preoperative HR = .80 (.38–1.68), p = .56 Adjusted postoperative HR = 2.06 (.97–4.40), p = .06 |
| Tully (32) | 226 CAG, AUS | 63 (17) | Median 4.9 years | MI, unstable angina, revascularization, CHF, sustained arrhythmia, stroke/CVA, LV failure, cardiac mortality, n = 65 (28.8) | BDI-II Cognitive factor | 4 days postoperative | LVEF, age, respiratory disease, CHF, renal disease, DM | Adjusted HR = 1.36 (1.02–1.82), p = . 04 |
AUS, Australia; BDI, Beck Depression Inventory; CAG, coronary artery graft; CCS, Canadian Cardiovascular Society; CES-D, Center for Epidemiological Studies-Depression; CHD, coronary heart disease; CHF, congestive heart failure; CI, confidence interval; CPB, cardiopulmonary bypass time; CVA, cerebrovascular accident; DASS, depression, anxiety and stress scales; DIS, diagnostic interview schedule; DM, diabetes mellitus; HAM-D, Hamilton Rating Scale for Depression; HR, hazard ratio; HUN, Hungary; HTN, hypertension; ICU, intensive care unit; LOS, length of stay; LV, left ventricular; LVEF, left ventricular ejection fraction; MDD, major depressive disorder; MI, myocardial infarction; NYHA, New York heart Association; OR, odds ratio; PCI, percutaneous coronary intervention; PCTA, percutaneous coronary transluminal angioplasty; PVD, peripheral vascular disease; RR, risk ratio; STAI-T, State Trait Anxiety Inventory-Trait; US, United States.