title: The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery.
abstract: BACKGROUND
  Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery.
  
  
  METHODS
  After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths.
  
  
  RESULTS
  During a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained.
  
  
  CONCLUSIONS
  Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Cserép
authors.forename: Eszter
authors.initials: E
authors.lastname: Losoncz
authors.forename: Piroska
authors.initials: P
authors.lastname: Balog
authors.forename: Tamás
authors.initials: T
authors.lastname: Szili-Török
authors.forename: András
authors.initials: A
authors.lastname: Husz
authors.forename: Boglárka
authors.initials: B
authors.lastname: Juhász
authors.forename: Miklós D
authors.initials: MD
authors.lastname: Kertai
authors.forename: János
authors.initials: J
authors.lastname: Gál
authors.forename: Andrea
authors.initials: A
authors.lastname: Székely
mesh_terms: D000368:Aged; D001007:Anxiety / Q000503:physiopathology* / Q000523:psychology; D006348:Cardiac Surgical Procedures / Q000523:psychology*; D003863:Depression / Q000503:physiopathology / Q000523:psychology; D004522:Educational Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires