Patients with depression are more than twice as likely to die after coronary artery bypass grafting (CABG) than patients without this mental illness, according to researchers.
Other studies examining the link between depression and CABG outcomes have been unable to reach solid conclusions either because of small sample size or short follow-up.
Dr. Blumenthal and colleagues, from Duke University Medical Centers in Durham, North Carolina, assessed the outcomes of 817 patients who underwent CABG between May 1989 and May 2001. The patients completed a validated test of depression before and 6 months after surgery. The average follow-up period was 5.2 years and 122 patients died.
Based on test scores, 38% of patients met the criterion for depression, after controlling for a variety of confounders, such as age, sex, diabetes, smoking, and number of grafts, moderate-to-severe depression at baseline independently increased the risk of death by 2.4-fold (p = 0.001). Similarly, depression that persisted from baseline to 6 months was linked to a 2.2-fold increased mortality risk (p = 0.015).
The results suggest that "physicians need to be more cognizant of the potential importance of depression," Dr. Blumenthal noted. "In addition to looking at conventional cardiac risk factors, such as hypertension and smoking, physicians need to pay attention to a person's mental state."
At the very least, having a CABG team member "who screens patients for depression would be worthwhile," he added. "If depression is detected, then a plan for ongoing monitoring and treatment if necessary could be generated."
"Effective treatments for depression are available, but whether these treatments would actually improve survival after CABG is unknown," Dr. Blumenthal pointed out. "But certainly improving quality of life would be a goal in and of itself."