title: Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study.
abstract: OBJECTIVE
  To explore the long-term effect of anxiety and depression on outcome after cardiac surgery. To date, the relationship between psychosocial factors and future cardiac events has been investigated mainly in population-based studies, in patients after cardiac catheterization or myocardial infarction.
  
  
  METHODS
  In total, 180 patients who underwent cardiac surgery using cardiopulmonary bypass were prospectively studied and followed up for 4 years. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI), living alone, and education level along with clinical risk factors and perioperative characteristics were assessed. Psychological self-report questionnaires were completed preoperatively and 6, 12, 24, 36, and 48 months after discharge. Clinical end-points were mortality and cardiac events requiring hospitalization during follow-up.
  
  
  RESULTS
  Average preoperative STAI-T score was 44.6 +/- 10. Kaplan-Meier analysis showed a significant effect of preoperative STAI-T >45 points (p = .008) on mortality. In multivariate models, postoperative congestive heart failure (OR: 10.8; 95% confidence interval [CI]: 2.9-40.1; p = .009) and preoperative STAI-T (score OR: 1.07; 95% CI: 1.01-1.15; p = .05) were independently associated with mortality. The occurrence of cardiovascular hospitalization was independently associated with postoperative intensive care unit days (OR: 1.41; 95% CI: 1.01-1.96; p = .045) and post discharge 6th month STAI-T (OR: 1.06; 95% CI:1.01-1.13; p = .03).
  
  
  CONCLUSIONS
  The results of the present study suggest that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and identification of patients at risk of mortality and cardiovascular morbidity after cardiac surgery.
authors.affiliation: Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. szekelya@kardio.hu
authors.forename: Andrea
authors.initials: A
authors.lastname: Székely
authors.forename: Piroska
authors.initials: P
authors.lastname: Balog
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Benkö
authors.forename: Tamás
authors.initials: T
authors.lastname: Breuer
authors.forename: Judit
authors.initials: J
authors.lastname: Székely
authors.forename: Miklós D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Ferenc
authors.initials: F
authors.lastname: Horkay
authors.forename: Mária S
authors.initials: MS
authors.lastname: Kopp
authors.forename: Julian F
authors.initials: JF
authors.lastname: Thayer
mesh_terms: D000368:Aged; D001007:Anxiety; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery; D003863:Depression; D005260:Female; D005500:Follow-Up Studies; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment