Anxiety predicts mortality and morbidity after coronary artery and valve surgery -: A 4-year follow-up study
Anxiety predicts mortality and morbidity after coronary artery and valve surgery -: A 4-year follow-up study
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DOI：
10.1097/psy.0b013e31814b8c0f
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发表时间：
2007-09-01
影响因子：
3.3
通讯作者：
Thayer, Juliam F.
中科院分区：
文献类型：
--
作者：
Szekely, Andrea;Balog, Piroska;Thayer, Juliam F.
目的：探讨焦虑和抑郁对心脏手术后结局的长期影响。迄今为止，心理社会因素与未来心脏事件之间的关系主要在心导管插入术或心肌梗死后的患者中进行基于人群的研究。方法：对 180 名接受体外循环心脏手术的患者进行前瞻性研究并随访 4 年。评估焦虑（斯皮尔伯格状态特质焦虑量表，STAI-S/STAI-T）、抑郁（贝克抑郁量表，BDI）、独居、教育水平以及临床危险因素和围手术期特征。术前和出院后6、12、24、36和48个月完成心理自我报告问卷。临床终点是随访期间的死亡率和需要住院治疗的心脏事件。结果：术前平均 STAI-T 评分为 44.6 +/- 10。Kaplan-Meier 分析显示术前 STAI-T > 45 分 (p = .008) 对死亡率有显着影响。在多变量模型中，术后充血性心力衰竭（OR：10.8；95% 置信区间 [CI]：2.9-40.1；p = .009）和术前 STAI-T（评分 OR：1.07；95% CI：1.01-1.15；p = .05）与死亡率独立相关。心血管住院的发生率与术后重症监护病房天数（OR：1.41；95% CI：1.01-1.96；p = .045）和出院后第 6 个月 STAI-T（OR：1.06；95% CI：1.01-1.13；p = .03）独立相关。结论：本研究的结果表明，对心理社会因素的评估，特别是对焦虑的持续评估，有助于对心脏手术后有死亡和心血管发病风险的患者进行风险分层和识别。
Objective: To explore the long-term effect of anxiety and depression on outcome after cardiac surgery. To date, the relationship between psychosocial factors and future cardiac events has been investigated mainly in population-based studies, in patients after cardiac catheterization or myocardial infarction. Methods: In total, 180 patients who underwent cardiac surgery using cardiopulmonary bypass were prospectively studied and followed up for 4 years. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI), living alone, and education level along with clinical risk factors and perioperative characteristics were assessed. Psychological self-report questionnaires were completed preoperatively and 6, 12, 24, 36, and 48 months after discharge. Clinical end-points were mortality and cardiac events requiring hospitalization during follow-up. Results: Average preoperative STAI-T score was 44.6 +/- 10. Kaplan-Meier analysis showed a significant effect of preoperative STAI-T > 45 points (p = .008) on mortality. In multivariate models, postoperative congestive heart failure (OR: 10.8; 95% confidence interval [CI]:2.9-40. 1; p = .009) and preoperative STAI-T (score OR: 1.07; 95% CI: 1.01-1.15; p =.05) were independently associated with mortality. The occurrence of cardiovascular hospitalization was independently associated with postoperative intensive care unit days (OR: 1.41; 95% CI: 1.01-1.96; p = .045) and post discharge 6th month STAI-T (OR: 1.06; 95% CI: 1.01-1.13; p = .03). Conclusions: The results of the present study suggest that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and identification of patients at risk of mortality and cardiovascular morbidity after cardiac surgery.