Depression increases risk of cardiac events after coronary artery bypass surgery

November 22, 2001

N.B. Please note that if you are outside North America please note that the embargo for Lancet press material is 0001 hours UK Time Friday 23 November 2001.

A study in this week's issue of THE LANCET highlights how depression is an important independent risk factor for cardiac events after coronary artery bypass graft (CABG) surgery. The study showed that depressed patients are more than twice as likely as non-depressed patients to die or be readmitted for cardiac causes in the 12 months after discharge from hospital.

The association of depression with adverse cardiac events has been investigated mainly in community populations, in patients undergoing catheterisation, or in patients who have had a heart attack. Ingrid Connerney and colleagues from the University of Maryland Medical Center and Columbia University College of Physicians & Surgeons, USA, assessed the effect of depression on outcomes after CABG surgery.

207 men and 102 women who had undergone CABG surgery were prospectively followed up for one year. Depression was assessed with a structured psychiatric interview (diagnostic interview schedule) and a questionnaire (Beck depression inventory) before discharge from hospital. Cardiac events included angina or heart failure that needed admission to hospital, heart attack, percutaneous transluminal coronary angioplasty, repeat CABG, and cardiac death. Non-cardiac events consisted of all other reasons for death or readmission to hospital.

63 patients (20%) were identified as having a major depressive disorder. At 12 months follow-up, 17 (27%) of these patients had a cardiac event compared with 25 of 246 (10%) who were not depressed. In addition to depression, four other factors had significant univariate associations with cardiac events: female gender, living alone, low ejection fraction of blood from the right ventricle (less than 0·35), and length of hospital stay. Depression did not predict deaths or admissions for non-cardiac events.

Ingrid Connerney comments: "Depression is thought of as an understandable and inevitable reaction to the severe circumstances accompanying CABG surgery, and as a result, it is not always treated. Data from this and other studies suggest that since the prevalence of depression is 20-25%, it is not an inevitable consequence of CABG surgery. Because depression after CABG surgery is associated with a significant independent risk of adverse cardiac events in the 12 months after surgery, would treatment of depression reduce adverse cardiac outcomes? Although assessment of depression in patients who have had cardiac events is difficult because symptoms of depression and cardiac disease overlap, results of many studies show that assessment of depression is not only possible, but could also be clinically important. In view of the strong relation between depression and adverse cardiac events, studies should be done to ascertain whether treatment of depression can reduce cardiac events after CABG surgery."
Contact: Dr Ingrid Connerney, c/o Ellen Beth Levitt, Director, Media Relations, University of Maryland Medical System and University of Maryland School of Medicine, 22 South Greene St., Baltimore, Maryland 21201, USA; T)+1 410 328 8919; M) +1 410 598 4711; E)


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