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Psychosocial and medical predictors of 14-year mortality and morbidity in male and female coronary artery bypass graft recipients: a prospective observational study

Published online by Cambridge University Press:  11 February 2021

Wolfgang Linden ,
Sandra Young ,
Andrew Ignaszewski  and
Tavis Campbell
Wolfgang Linden*
Affiliation:
Department of Psychology, University of British Columbia, Vancouver, Canada
Sandra Young
Affiliation:
Department of Psychology, University of British Columbia, Vancouver, Canada Department of Psychology, University of Calgary, Vancouver, Canada
Andrew Ignaszewski
Affiliation:
Division of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
Tavis Campbell
Affiliation:
Department of Psychology, University of Calgary, Vancouver, Canada
*
Author for correspondence: Wolfgang Linden, E-mail: wlinden@psych.ubc.ca
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Abstract

Background

Psychosocial factors may influence mortality and morbidity after coronary bypass surgery (CABG), but it is unclear when, post-surgery, they best predict the outcome, if they interact, or whether results differ for men and women.

Methods

This prospective, observational study assessed depression symptoms, social support, marital status, household responsibility, functional impairment, mortality and need for further coronary procedures over 14 years of follow-up. Data were collected in-hospital post-CABG and at home 1-year later. Mortality and subsequent cardiac procedure data were extracted from a Cardiac Registry.

Results

Of 296 baseline participants, 78% (43% were women) completed data at 1-year post-CABG. Long-term survival was shorter with 1-year depression and lower household responsibility but that was not true for the measures taken at baseline [HR for depression = 1.27; 95% CI 1.02–1.59 v. 0.99 (0.78–1.25), and HR = 0.71; 95% CI 0.52–0.97 v. 0.97 (0.80–1.16)] for household responsibility. An interaction between depression symptoms and social support at year 1 [χ2 (11) = 111.05, p < 0.001] revealed a greater hazard of mortality d with increased depression only at mean (HR = 1.67; 95% CI 1.21–2.26) and high social support (HR = 2.23; 95% CI 1.46–3.40). Depression also accounted for increased event recurrence. There were no significant interactions of sex with medical long-term outcomes.

Conclusions

In a sex-balanced sample, depression and household responsibility measured at 1-year post-CABG were associated with significant variance in unadjusted and adjusted predictor models of long-term mortality whereas the same indices determined right after the procedure were not significant predictors.

Keywords

coronary artery bypass graftcoronary artery diseasemorbiditymortalitypsychosocial functioning
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3460 - 3471
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Aiken, S. A., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Sage Publications.Google Scholar
Beck, A. T., Ward, C., & Mendelson, M. (1961). Beck depression inventory (BDI). Archives of General Psychiatry, 4, 561–571.10.1001/archpsyc.1961.01710120031004CrossRefGoogle Scholar
Blauwet, L. A., Hayes, S. N., McManus, D., Redberg, R. F., & Walsh, M. N. (2007). Low rate of sex-specific result reporting in cardiovascular trials. Mayo Clinic Proceedings, 82(2), 166–170. doi: 10.4065/82.2.166CrossRefGoogle ScholarPubMed
Blumenthal, J. A., Lett, H. S., Babyak, M. A., White, W., Smith, P. K., Mark, D. B., & Newman, M. F. (2003). Depression as a risk factor for mortality after coronary artery bypass surgery. The Lancet, 362(9384), 604–609. doi: http://dx.doi.org/10.1016/S0140-6736(03)14190-6.CrossRefGoogle ScholarPubMed
Bryant, K. B., Jannat-Khah, D. P., Cornelius, T., Khodneva, Y., Richman, J., Fleck, E. M., … Moisem, N. (2020). Time-varying depressive symptoms and cardiovascular and all-cause mortality: Does the risk vary by age or sex? Journal of the American Heart Association, 118, e016661.10.1161/JAHA.120.016661CrossRefGoogle Scholar
Bugiardini, R., Estrada, J. L., Nikus, K., Hall, A. S., & Manfrini, O. (2010). Gender bias in acute coronary syndromes. Current Vascular Pharmacology, 8(2), 276–284.10.2174/157016110790887018CrossRefGoogle ScholarPubMed
Buxbaum, J. (1967). Effect of nurturance on wives’ appraisals of their marital satisfaction and the degree of their husbands’ aphasia. Journal of Consulting Psychology and Health, 31(3), 240–243.10.1037/h0024650CrossRefGoogle ScholarPubMed
Chen, H., Zhang, L., Zhang, M. Song, X., Zhang, H., Liu, Y., & Liv, S. (2013). Relationship of depression, stress and endothelial function in stable angina patients. Physiology and Behavior, 152–158. Available from http://118C10.1016/j.physbeh.2013.05.024.10.1016/j.physbeh.2013.05.024CrossRefGoogle ScholarPubMed
Cohen, S. S., Mermelstein, R. J., Kamarck, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In Sarason, I. G. & Sarason, B. R. (Eds.), Social support: Theory, research, And applications, Martinus Nijhoff.Google Scholar
De Jonge, P., Honig, A., Van Melle, J. P., Schene, J. H., Kuyper, A. M., Tulner, D., … investigators, M. I. N. D.-I. T. (2007). Nonresponse to treatment for depression following myocardial infarction: Association with subsequent cardiac events. American Journal of Psychiatry, 164(9), 1371–3178.10.1176/appi.ajp.2007.06091492CrossRefGoogle ScholarPubMed
Frasure-Smith, N., Lesperance, F., Habra, M., Talajic, M., Khairy, P., Dorian, P., & Roy, D. (2009). Elevated depression symptoms predict long-term cardiovascular mortality in patients with atrial fibrillation and heart failure. Circulation, 120(2), 134–140. doi: 10.1161/circulationaha.109.851675.CrossRefGoogle ScholarPubMed
Fredericks, S., Lapum, J., & Lo, J. (2012). Anxiety, depression, and self-management: A systematic review. Clinical Nursing Research, 21(4), 411–430. doi: 10.1177/1054773812436681.CrossRefGoogle ScholarPubMed
Freedland, K. E., & Carney, R. M. (2013). Depression as a risk factor for adverse outcomes in coronary heart disease, BMC Medicine, 11, 131. Available from http://www.biomedcentral.com/1741-7015/11/131.10.1186/1741-7015-11-131CrossRefGoogle ScholarPubMed
Goodman, S. G., Huang, W., Yan, A. T., Budaj, A., Kennelly, B. M., Gore, J. M., & Anderson, F. A Jr. (2009). The expanded Global Registry of Acute Coronary Events: Baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. American Heart Journal, 158(2), 193–201.e195. doi: http://dx.doi.org/10.1016/j.ahj.2009.06.003.CrossRefGoogle ScholarPubMed
Goyal, T. M., Idler, E. L., Krause, T. J., & Contrada, R. J. (2005). Quality of life following cardiac surgery: Impact of the severity and course of depressive symptoms. Psychosomatic Medicine, 67(5), 759–765. doi: 10.1097/01.psy.0000174046.40566.80.CrossRefGoogle ScholarPubMed
Herlitz, J., Wiklund, I., Caidahl, K., Hartford, M., Haglid, M., Karlsson, B.W., & Karlsson, T. (1998). The feeling of loneliness prior to coronary artery bypass grafting might be a predictor of short- and long-term postoperative mortality. European Journal of Vascular and Endovascular Surgery, 16(2), 120–125. doi: http://dx.doi.org/10.1016/S1078-5884(98)80152-4.CrossRefGoogle ScholarPubMed
Humphries, K.H., Izadnegadar, M., Sedlak, T., Saw, J., Johnston, N., Schenck-Gustafsson, K., … Bairey Merz, C.N. (2017). Sex differences in cardiovascular disease – impact on care and outcomes. Frontiers in Neuroendocrinology, 46, 46–70. doi: http://dx.doi.rg/19.1016/j.yfrne.2017.04.001.CrossRefGoogle ScholarPubMed
Jackson, L., Leclerc, J., Erskine, Y., & Linden, W. (2005). Getting the most out of cardiac rehabilitation: A review of referral and adherence predictors. Heart (British Cardiac Society), 91(1), 14–19. doi: 10.1136/hrt.2004.045559.CrossRefGoogle ScholarPubMed
Kendel, F., Dunkel, A., Muller-Tasch, T., Steinberg, K., Lehmkuhl, E., Hetzer, R., & Regitz-Zagrosek, V. (2011). Gender differences in health-related quality of life after coronary bypass surgery: Results from a 1-year follow-up in propensity-matched men and women. Psychosomatic Medicine, 73, 280–285. doi: 10.1097/PSY.0b013e3182114d35.CrossRefGoogle ScholarPubMed
Keogh, B., & Kinsman, R. (2004). Fifth national adult cardiac surgical database report 2003: improving outcomes for patients. Dendrite Clinical Systems.Google Scholar
Kerns, R.D., Turk, D.C., & Rudy, T.E. (1985). The west haven-yale multidimensional pain inventory (WHYMPI). Pain, 23(4), 345–356. doi: http://dx.doi.org/10.1016/0304-3959(85)90004-1.CrossRefGoogle ScholarPubMed
Khoueiry, G., Flory, M., Abi Rafeh, N., Zgheib, M.H., Goldman, M., Abdallah, T., & McGinn, J.T. (2011). Depression, disability, and quality of life after off-pump coronary artery bypass grafting: A prospective 9-month follow-up study. Heart & Lung: Journal of Acute and Critical Care, 40(3), 217–225. doi: http://dx.doi.org/10.1016/j.hrtlng.2010.03.001.CrossRefGoogle ScholarPubMed
King, K. B., & Reis, H. T. (2012). Marriage and long-term survival after coronary artery bypass grafting. Health Psychology, 31(2), 55–62. doi: 10.1037/a0025061.CrossRefGoogle ScholarPubMed
Lear, S. A., Ignaszewski, A., Linden, W., Brozic, A., Kiess, M., Spinelli, J., … Frohlich, J. J. (2003). The extensive lifestyle management intervention (ELMI) following cardiac rehabilitation trial. European Heart Journal, 24, 1920–1927.10.1016/j.ehj.2003.08.015CrossRefGoogle ScholarPubMed
Lehmkuhl, E., Kendel, F., Gelbrich, G., Dunkel, A., Oertelt-Prigione, S., Babitsch, B., & Regitz-Zagrosek, V. (2012). Gender-specific predictors of early mortality after coronary artery bypass graft surgery. Clinical Research in Cardiology, 101(9), 745–751. doi: 10.1007/s00392-012-0454-0.CrossRefGoogle ScholarPubMed
Lichtman, J.H., Froelicher, A.S., Blumenthal, J.A., Carney, R.M., Doering, L.V., Frasure-Smith, N., … on behalf of the American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: Systematic review and recommendations. A scientific statement from the American Heart Association. Circulation, 129, 1350–1369. doi: 10.1161/CIR00000000000000019.CrossRefGoogle ScholarPubMed
Linden, W., Phillips, M. J., & Leclerc, J. (2007). Psychological treatment of cardiac patients: A meta-analysis. European Heart Journal, 28(24), 2972–2984. doi: 10.1093/eurheartj/ehm504.CrossRefGoogle ScholarPubMed
Nielsen, S., Giang, K. W., Wallinder, A., Rosengren, A., Pivodic, A., Jeppsson, A., & Karlsson, M. (2019). Social factors, sex, and mortality risk after coronary artery bypass grafting: A population based cohort study. Journal of the American Heart Association, 8, e011490. doi: 10.1161/JAHA.118.011490CrossRefGoogle ScholarPubMed
Olafiranye, O., Jean-Louis, G., Antwi, M., Zizi, F., Shaw, R., Brimah, P., & Ogedegbe, G. (2012). Functional capacity is a better predictor of coronary heart disease than depression or abnormal sleep duration in Black and White Americans. Sleep Medicine, 13(6), 728–731. doi: 10.1016/j.sleep.2012.01.015.CrossRefGoogle ScholarPubMed
Parry, M., Watt-Watson, J., Hodnett, E., Tranmer, J., Dennis, C. L., & Brooks, D. (2010). Pain experiences of men and women after coronary artery bypass graft surgery. Journal of Cardiovascular Nursing, 25(3), E9–E15.10.1097/JCN.0b013e3181cd66beCrossRefGoogle ScholarPubMed
Schrader, G., Cheok, F., Hordacre, A. L., & Guiver, N. (2004). Predictors of depression three months after cardiac hospitalization. Psychosomatic Medicine, 66(4), 514–520. doi: 10.1097/01.psy.0000128901.58513.db.CrossRefGoogle ScholarPubMed
Schrader, G., Cheok, F., Hordacre, A. L., & Marker, J. (2006). Predictors of depression 12 months after cardiac hospitalization: The Identifying Depression as a Comorbid Condition study. Australian and New Zealand Journal of Psychiatry, 40(10/11), 1025–1030. doi: 10.1111/j.1440-1614.2006.01927.x.Google ScholarPubMed
Shahian, D. M., O'Brien, S. M., Filardo, G., Ferraris, V. A., Haan, C. K., Rich, D. B., … Anderson, R. P. (2009). The society of thoracic surgeons 2008 cardiac surgery risk models: Part 1—coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88, S2–S22.10.1016/j.athoracsur.2009.05.053CrossRefGoogle Scholar
Sullivan, M. D., LaCroix, A. Z., Spertus, J. A., Hecht, J., & Russo, J. (2003). Depression predicts revascularization procedures for 5 years after coronary angiography. Psychosomatic Medicine, 65(2), 229–236. doi: 10.1097/01.psy.0000058370.50240.aa.CrossRefGoogle ScholarPubMed
Tamis-Holland, J. E., Lu, J., Korytkowski, M., Magee, M., Rogers, W. J., Lopes, N., & Jacobs, A. K. (2013). Sex differences in presentation and outcome among patients with type 2 diabetes and coronary artery disease treated with contemporary medical therapy with or without prompt revascularization: A report from the BARI 2D trial (Bypass Angioplasty Revascularization Investigation 2 Diabetes). Journal of the American College of Cardiology, 61(17), 1767–1776. doi: http://dx.doi.org/10.1016/j.jacc.2013.01.062CrossRefGoogle ScholarPubMed
Vittinghoff, E., & McCulloch, C. E. (2007). Relaxing the rule of ten events per variable in logistic and Cox regression. American Journal of Epidemiology, 165(6), 710–718. doi: 10.1093/aje/kwk052.CrossRefGoogle ScholarPubMed
Wu, C., Camacho, F. T., Wechsler, A. S., Lahey, S., Culliford, A. T., Jordan, D., & Hannan, E. L. (2012). Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation, 125(20), 2423–2430.10.1161/CIRCULATIONAHA.111.055939CrossRefGoogle ScholarPubMed
Young, S., Linden, W., Ignaszewski, A., Con, A. H., Terhaag, S., & Campbell, T. (2019). Psychosocial and medical predictors of 1-yr functional outcome in male and female coronary bypass recipients. Heart and Mind, 3, 113–121. doi: 10.4103/hm.hm_64_19.Google Scholar