title: Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgery.
abstract: 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.
authors.affiliation: Cardiac and Thoracic Surgical Unit, Department of Medicine, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Bennetts
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.forename: Andrew D
authors.initials: AD
authors.lastname: McGavigan
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Turnbull
authors.forename: Helen R
authors.initials: HR
authors.lastname: Winefield
mesh_terms: 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*