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TREATING DEPRESSION IMPORTANT FOR REDUCING DEATH AFTER BYPASS SURGERY (p 604)
August 20, 2003Issue 23 August 2003
Embargoed 0001 h (London time) 22 August 2003.
Authors of a US study in this week's issue of THE LANCET highlight how a substantial proportion of patients undergoing coronary artery bypass surgery are clinically depressed-and that treating depression after surgery could substantially reduce the risk of death among these patients.
Depression is an established risk factor for coronary relapse after bypass surgery; however no previous study has assessed the effect of depression on mortality after bypass surgery.
James Blumenthal from Duke University Medical Center, North Carolina, USA, studied 817 patients undergoing bypass surgery between 1989 and 2001. Patients were assessed for depression before surgery, 6 months after surgery, and were followed-up for up to 12 years.
There were 122 deaths (15%) in an average follow-up of just over five years. Around 40% of patients met the criteria for depression, two-thirds of whom had mild depression, the other third moderate to severe depression. Patients with moderate to severe depression at baseline and those with mild depression sustained from initial to six-month assessment were more than twice as likely to die than patients who were not depressed.
James Blumenthal comments: "These findings have important implications for the management of patients who have undergone coronary artery bypass grafting [CABG].
Despite advances in the medical management of patients after CABG, the prognostic importance of clinical depression provides a further opportunity to reduce adverse outcomes associated with the procedure by treating depressed patients after surgeryWe observed that, after adjustment for other risk factors, depression was associated with a two-to-three-fold increase in risk. Thus, many patients who undergo CABG are at increased risk of death because they are clinically depressed; this risk could be reduced by treatment of depression after surgery. Future studies should investigate the mechanisms responsible for this increased risk and whether treating depression can reduce the risk of death in depressed patients undergoing CABG."
Lancet
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