Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: A five year longitudinal cohort study

P.J. Tully, H.R. Winefield, R.A. Baker, Johan Denollet, S.S. Pedersen, G.A. Wittert, D. Turnbull

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Abstract

Background
Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.
Methods
Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.
Results
In the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.
Conclusions
Generalized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.
Keywords
Coronary artery bypass grafts, Coronary heart disease, Depression, Generalized anxiety disorder, Prognosis, Survival analysis, Cardiovascular disease
Original languageEnglish
Article number14
JournalBioPsychoSocial Medicine
Volume9
DOIs
Publication statusPublished - 2015

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Depression
Confidence Intervals
Survival Analysis
Anhedonia
Agoraphobia
Panic Disorder
Self Report
Body Mass Index
Odds Ratio
Interviews

Cite this

@article{33248463508546eba26fbeaa5c1ebc11,
title = "Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: A five year longitudinal cohort study",
abstract = "BackgroundAlthough depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.MethodsBefore coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 {\%} female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.ResultsIn the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 {\%} of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 {\%} confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 {\%} CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 {\%} CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.ConclusionsGeneralized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.KeywordsCoronary artery bypass grafts, Coronary heart disease, Depression, Generalized anxiety disorder, Prognosis, Survival analysis, Cardiovascular disease",
author = "P.J. Tully and H.R. Winefield and R.A. Baker and Johan Denollet and S.S. Pedersen and G.A. Wittert and D. Turnbull",
year = "2015",
doi = "10.1186/s13030-015-0041-5",
language = "English",
volume = "9",
journal = "BioPsychoSocial Medicine",
issn = "1751-0759",
publisher = "BioMed Central",

}

Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery : A five year longitudinal cohort study. / Tully, P.J.; Winefield, H.R.; Baker, R.A.; Denollet, Johan; Pedersen, S.S.; Wittert, G.A.; Turnbull, D.

In: BioPsychoSocial Medicine, Vol. 9, 14, 2015.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery

T2 - A five year longitudinal cohort study

AU - Tully, P.J.

AU - Winefield, H.R.

AU - Baker, R.A.

AU - Denollet, Johan

AU - Pedersen, S.S.

AU - Wittert, G.A.

AU - Turnbull, D.

PY - 2015

Y1 - 2015

N2 - BackgroundAlthough depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.MethodsBefore coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.ResultsIn the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.ConclusionsGeneralized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.KeywordsCoronary artery bypass grafts, Coronary heart disease, Depression, Generalized anxiety disorder, Prognosis, Survival analysis, Cardiovascular disease

AB - BackgroundAlthough depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.MethodsBefore coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.ResultsIn the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.ConclusionsGeneralized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.KeywordsCoronary artery bypass grafts, Coronary heart disease, Depression, Generalized anxiety disorder, Prognosis, Survival analysis, Cardiovascular disease

U2 - 10.1186/s13030-015-0041-5

DO - 10.1186/s13030-015-0041-5

M3 - Article

VL - 9

JO - BioPsychoSocial Medicine

JF - BioPsychoSocial Medicine

SN - 1751-0759

M1 - 14

ER -