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(Circulation. 2005;111:271-277.)
© 2005 American Heart Association, Inc.

Cardiovascular Surgery

Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery

Susmita Mallik, MD; Harlan M. Krumholz, MD, SM; Zhen Qiu Lin, PhD; Stanislav V. Kasl, PhD; Jennifer A. Mattera, MPH; Sarah A. Roumains, RN; Viola Vaccarino, MD, PhD

From the Department of Medicine, Division of General Medicine, Emory University School of Medicine, Atlanta, Ga (S.M.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (H.M.K.); Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (H.M.K., Z.Q.L., J.A.M., S.A.R.); Department of Epidemiology and Public Health, Yale University School of Medicine, Boston, Mass (S.V.K.); Department of Medicine, Division of Cardiology, Emory University School of Medicine, and the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga (V.V.).

Reprint requests to Susmita Mallik, MD, Department of Medicine, Emory University, Room 473, Faculty Office Bldg, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303. E-mail smallik{at}emory.edu

Received June 23, 2004; revision received October 6, 2004; accepted October 12, 2004.

Background— Depression is an established independent prognostic factor for mortality, readmission, and cardiac events after CABG surgery. However, limited data exist on whether depression influences functional outcomes after CABG.

Methods and Results— We followed 963 patients who underwent first CABG between February 1999 and February 2001. At baseline and at 6 months after CABG, we interviewed patients to assess depressive symptoms using the Geriatric Depression Scale (GDS) and physical function using the Short Form-36 Physical Component Scale (PCS). The patient’s physical function was considered improved if the PCS score increased 5 points at 6 months. Patients with high GDS scores were younger, were more often female, and had worse physical function and higher comorbidity than patients with low GDS scores. Rates of improvement in physical function were 60.1% for a GDS score <5 (below 75th percentile), 49.8% for a GDS score between 5 and 9 (75th to 90th percentile), and 39.7% for a GDS score 10 (90th percentile; P=0.002 for the trend). Depressive symptoms remained a significant independent predictor of lack of functional improvement after adjustment for severity of coronary artery disease, angina class, baseline PCS score, and medical history. A GDS score 10 was a stronger inverse risk factor for functional improvement after CABG than such traditional measures of disease severity as previous myocardial infarction, heart failure on admission, history of diabetes, and left ventricular ejection fraction.

Conclusions— Higher levels of depressive symptoms at the time of CABG are a strong risk factor for lack of functional benefits 6 months after CABG.

Key Words: coronary artery bypass • coronary disease • depression • outcome

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