Abstract 17045: The Association of Depressive Symptoms Prior to Cardiovascular Surgery to Death and the Mitigating Effects of Cardiac Rehabilitation Attendance
Introduction: Depressive symptoms have been shown to be associated with poor cardiovascular outcomes. Cardiac rehabilitation (CR) has been shown to improve outcomes after cardiovascular surgery, but whether it attenuates the negative effects of depressive symptoms on outcomes needs evaluation.
Methods: A total of 118 patients undergoing cardiovascular surgery (CABG: 38.1%, Valve: 24.8%, Other: 37.1%) and completed a Patient Health Questionnaire (PHQ)-9 were studied. The PHQ-9 was completed prior to surgery at an outpatient visit (median days completed prior to surgery: 310) and scores were stratified into categories of none-mild (NO-MILD, n=98) and moderate-severe (MOD-SEV, n=20) depressive symptoms. Multivariable Cox hazard regression was utilized to determine the association of pre-surgery PHQ-9 depressive symptoms to death (length of follow-up: NO-MILD=431±343, MOD-SEV=393±324, p=0.65).
Results: MOD-SEV patients were significantly younger (60.8±12.2 vs. 67.0±10.2 years, p=0.02) and more often smokers (75.0% vs. 36.7%, p=0.002) than NO-MILD. However, being male (61.9%), having hypertension (90.7%), diabetes (61.0%), heart failure (39.0%), and renal failure (29.7%) were similar between the groups. Length of stay was also similar (MOD-SEV: 8.8±5.6 vs. NO-MILD: 7.5±5.2 days, p=0.32). CR was attended by 61.2 % of NO-MILD and 45.5% by MOD-SEV patients. Death occurred in 6.1% and 25.0% of NO-MILD and MOD-SEV patients (p=0.02), respectively. MOD-SEV depressive symptoms were significantly associated with death (hazard ratio [HR]=4.43, p=0.01). This association remained after adjustment by baseline risk factors (HR=4.14, p=0.03), but was attenuated when adjusted by CR attendance (HR=2.12, p=0.28). Among MOD-SEV patients, attendance of CR was significantly associated with a reduced risk of death (HR=0.26, p=0.02).
Conclusion: The presence of MOD-SEV depressive symptoms prior to cardiovascular surgery was highly predictive of death despite adjustment by baseline risk factors. However, attendance of CR appears to decrease this risk. Further study is required to determine whether other factors contribute to this association.
Author Disclosures: T.L. Bair: None. J. Benuzillo: None. V.T. Le: None. H.T. May: None. K.U. Knowlton: None. D.L. Lappé: None. J.B. Muhlestein: None.
- © 2016 by American Heart Association, Inc.