Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgery.
OBJECTIVE
We sought to determine whether preoperative and postoperative anxiety, depression, and stress symptoms were associated with atrial fibrillation (AF) after cardiac surgery.


METHODS
Two hundred and twenty-six cardiac surgery patients completed measures of depression, anxiety, and general stress before surgery, and 222 patients completed these measures after surgery. The outcome variable was new-onset AF, confirmed before the median day of discharge (day 5) after cardiac surgery during the index hospitalization.


RESULTS
Fifty-six (24.8%) patients manifested incident AF, and they spent more days in hospital (mean [M], 7.3; standard deviation [SD], 4.6) than patients without AF (M, 5.5; SD, 1.4; P < .001). No baseline psychological predictors were associated with AF. When postoperative distress measures were considered, anxiety was associated with increased odds of AF (odds ratio, 1.09; 95% confidence interval, 1.00 to 1.18; P = .05). This analysis also showed that age was significantly associated with AF (odds ratio, 1.07; 95% confidence interval, 1.03 to 1.12; P < .001). Analyses specific to the symptomatic expression of anxiety indicated that somatic (ie, autonomic arousal) and cognitive-affective (ie, subjective experiences of anxious affect) symptoms were associated with incident AF.


CONCLUSIONS
Anxiety symptoms in the postoperative period were associated with AF. Hospital staff in acute cardiac care and cardiac rehabilitation settings should observe anxiety as related to AF after cardiac surgery. It is not clear how anxious cognitions influence the experience of AF symptoms, and whether symptoms of anxiety commonly precede AF.
Tully
Phillip J
PJ
Cardiac and Thoracic Surgical Unit, Department of Medicine, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
Bennetts
Jayme S
JS
Baker
Robert A
RA
McGavigan
Andrew D
AD
Turnbull
Deborah A
DA
Winefield
Helen R
HR
D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000150:complications*; D001281:Atrial Fibrillation / Q000209:etiology* / Q000451:nursing / Q000523:psychology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000451:nursing; D003863:Depression / Q000150:complications*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011594:Psychometrics; D012307:Risk Factors; D013021:South Australia; D013315:Stress, Psychological / Q000150:complications*