Original articles
Cardiovascular
Depression Predicts Mortality Following Cardiac Valve Surgery

https://doi.org/10.1016/j.athoracsur.2004.09.047Get rights and content

Background

Depression is associated with mortality in several cardiovascular populations, but has not been evaluated in patients undergoing cardiac valve surgery. Because identifying nonsurgical mediators of survival is important for accurate risk adjustment and the development of interventions to improve outcomes of care, we evaluated the hypothesis that depression predicts mortality following cardiac valve surgery.

Methods

This prospective cohort study enrolled 648 patients undergoing valve surgery at 14 Veteran Administration hospitals. A preoperative mental health inventory (MHI) depression screen was performed in all patients and patients were classified as depressed or not depressed using the standard MHI cutoff score of less than or equal to 52. Multivariable logistic regression was used to evaluate the association between depression and 6-month all-cause mortality, adjusting for other clinical risk variables.

Results

Overall, 29.2% (189/648) of the patients were depressed at baseline. Depressed patients were younger, more frequently had New York Heart Association class III/IV symptoms, and more likely required emergent surgery, preoperative intravenous nitroglycerin, or intraaortic balloon pump. Unadjusted 6-month mortality was 13.2% for depressed patients compared with 7.6% for nondepressed patients (p = 0.03). In multivariable analyses, depression remained significantly associated with mortality (odds ratio 1.90; 95% confidence interval 1.07 to 3.40, p = 0.03). These findings were consistent across subgroups of patients undergoing aortic valve replacement, mitral valve replacement and valve replacement without coronary artery bypass graft.

Conclusions

Preoperative depression is an independent risk factor for mortality following cardiac valve surgery. Depression screening should be incorporated into preoperative risk stratification, and future studies are warranted to determine if preoperative or postoperative interventions to treat depression can improve outcomes.

Section snippets

Patients

Patients were enrolled in the Department of Veteran's Affairs Cooperative Study in Health Services #5, “Processes, Structures, and Outcomes of Care in Cardiac Surgery” (PSOCS), a multicenter, prospective, observational study investigating the linkages between processes and structures of care and risk-adjusted outcomes. Details of the study have been published previously [11]. Seven hundred thirty-four variables representing patient-related risk factors, processes, structures and outcomes of

Results

Baseline characteristics of the study population are listed in Table 1. Compared to nondepressed patients, depressed patients were younger and more likely had New York Heart Association (NYHA) functional class III or IV symptoms. In addition, depressed patients more likely required urgent or emergent surgery, preoperative intravenous nitroglycerin or peroperative intraaortic balloon pump.

Unadjusted 6-month mortality was 13.2% for depressed patients and 7.6% for nondepressed patients. Univariate

Comment

The objective of this study was to determine the prevalence of preoperative depression and whether depression was predictive of mortality following valve surgery in a multicenter cohort of VA patients. We found that nearly 1 in 3 patients had significant depressive symptoms at baseline. Furthermore, preoperative depression was an independent predictor of 6-month mortality, with a 1.9-fold increased odds of death, even after adjustment for the traditional clinical risk variables. This finding

References (30)

  • P.A. Pirraglia et al.

    Depressive symptomatology in coronary artery bypass graft surgery patients

    Int J Geriatr Psychiatry

    (1999)
  • R.A. Baker et al.

    Preoperative depression and mortality in coronary artery bypass surgery: preliminary findings

    ANZ J Surg

    (2001)
  • M.M. Burg et al.

    Presurgical depression predicts medical morbidity 6 months after coronary artery bypass graft surgery

    Psychosom Med

    (2003)
  • A.L. Shroyer et al.

    : The processes, structures, and outcomes of care in cardiac surgery study protocol

    Med Care

    (1995)
  • D.M. Berwick et al.

    Performance of a five-item mental health screening test

    Med Care

    (1991)
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