Survival after coronary artery bypass surgery depends on the patient’s state of mind in addition to the condition of the patient’s heart, according to researchers at the University of Maryland Medical Center and Columbia University Medical Center. They found that patients who were depressed following heart bypass surgery were twice as likely to die from heart problems within seven years of surgery compared to those who were not depressed. Results of the study were presented at the American Psychosomatic Society Annual Meeting on March 4, 2006 in Denver, Colorado.
“Physicians and patients need to be aware of the increased risks faced by patients suffering from depression,” says principal investigator Ingrid Connerney, Dr. PH, director of Clinical Effectiveness at the University of Maryland Medical Center and a clinical assistant professor of surgery at the University of Maryland School of Medicine. “The next logical step in our research is to understand why and how depression is associated with increased mortality,” she adds.
The study included 309 patients (207 men and 102 women) who had bypass surgery at the University of Maryland Medical Center in Baltimore in 1997. The researchers looked at whether depression prior to leaving the hospital had an impact on long term survival.
“We found that depressed patients were twice as likely to die of cardiac causes compared to those who were not depressed,” says senior investigator Peter Shapiro, M.D., associate professor of clinical psychiatry, Columbia University College of Physicians & Surgeons.
The researchers found that almost 20 percent of the depressed patients died from cardiac causes in the seven-year follow-up period, compared to 12 percent of the patients who were not depressed after their surgery. Overall, 24 percent of the patients in the study (74 out of 309) died within seven years after surgery. Of those, 41 of the 74 patients died of cardiac causes.
For the study, Dr. Connerney performed a detailed psychiatric interview with each patient and asked each of them to fill out a questionnaire prior to discharge from the hospital. Patients were assessed at 12 months following surgery and again at 5-7 years.
The increased risk faced by depressed patients could not be explained by differences in demographics, severity of disease, or other factors. “We looked at many factors, including the patient’s age, gender, marital status, smoking behavior, and depression,” explains Dr. Connerney. She adds, “It turned out that only depression, heart condition, and insulin dependent diabetes were linked with cardiac mortality. In contrast, we did not see a significant relationship between depression and other causes of mortality.”
Coronary artery bypass surgery enables the heart to pump blood around blocked arteries and to alleviate severe chest pain. Various studies have found that following bypass surgery, about 20 percent of patients suffer from depression.
Also collaborating on the study with Dr. Connerney and Dr. Shapiro were Richard Sloan, Ph.D., Columbia University College of Physicians & Surgeons, Emilia Bagiella, Ph.D. from the Mailman School of Public Health at Columbia University, Charlotte Seckman, M.S., from the National Institute of Health, and Joseph McLaughlin, M.D., of the University of Maryland School of Medicine.
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