Research progress of anxiety and depression in adult patients undergoing cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Liping , LI Yongnan , LU Xiaofeng , WANG Xu , LIU Debin ,  GAO Bingren

Department of Cardiovascular Surgery, The Second Hospital of Lanzhou University, Lanzhou, 730030, P.R.China;

Corresponding author：

GAO Bingren, Email: gaobingren2016@163.com

Keywords：

Cardiac surgery; anxiety; depression; antidepressants; perioperative period

DOI：

10.7507/1007-4848.201908075

Video：

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Anxiety is a strong behavioral and psychological reaction with fear components, while depression is a mental disorder dominated by high or low mood, both of which are accompanied by cognitive and behavioral changes, and are common comorbidities in patients with heart disease. Cardiac surgery is one of the important factors which trigger specific emotional and physiological reactions of patients. Persistent or initial depression and anxiety after surgery will not only increase surgical complications, short- or long-term mortality and medical costs, but also seriously affect patients' social function and quality of life. With the transformation of bio-psycho-social medical model, it is necessary to evaluate the perioperative psychological state and biological risk of patients undergoing cardiac surgery. This article reviews the characteristics, related mechanisms and therapeutic interventions of anxiety and depression in patients undergoing cardiac surgery.

Citation： WANG Liping, LI Yongnan, LU Xiaofeng, WANG Xu, LIU Debin, GAO Bingren. Research progress of anxiety and depression in adult patients undergoing cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(5): 574-578. doi: 10.7507/1007-4848.201908075 Copy

1.	Modica M, Castiglioni P, Minotti A, et al. Psychological profile in coronary artery by-pass graft patients vs. valve replacement patients entering cardiac rehabilitation after surgery. Sci Rep, 2018, 8(1): 14381.
2.	Liu J, Dong Q, Lu X, et al. Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder. J Affect Disord, 2020, 260: 91-96.
3.	Stenman M, Holzmann MJ, Sartipy U. Association between preoperative depression and long-term survival following coronary artery bypass surgery--a systematic review and meta-analysis. Int J Cardiol, 2016, 222: 462-466.
4.	Geulayov G, Novikov I, Dankner D, et al. Symptoms of depression and anxiety and 11-year all-cause mortality in men and women undergoing coronary artery bypass graft (CABG) surgery. J Psychosom Res, 2018, 105: 106-114.
5.	Flaherty LB, Wood T, Cheng A, et al. Pre-existing psychological depression confers increased risk of adverse cardiovascular outcomes following cardiac surgery: a systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2017, 154(5): 1578-1586.
6.	Poole L, Ronaldson A, Kidd T, et al. Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery. J Behav Med, 2017, 40(2): 249-258.
7.	Hernández-Palazón J, Fuentes-García D, Falcón-Araña L, et al. Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: contributing factors and postoperative morbidity. J Cardiothorac Vasc Anesth, 2018, 32(1): 236-244.
8.	Székely A, Balog P, Benkö E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study. Psychosom Med, 2007, 69(7): 625-631.
9.	Tully PJ, Baker RA, Turnbull DA, et al. Negative emotions and quality of life six months after cardiac surgery: the dominant role of depression not anxiety symptoms. J Behav Med, 2009, 32(6): 510-522.
10.	Açıkel MET. Evaluation of depression and anxiety in coronary artery bypass surgery patients: a prospective clinical study. Braz J Cardiovasc Surg, 2019, 34(4): 389-395.
11.	Botzet K, Dalyanoglu H, Schäfer R, et al. Anxiety and depression in patients undergoing mitral valve surgery: a prospective clinical Study. Thorac Cardiovasc Surg, 2018, 66(7): 530-536.
12.	Williams JB, Alexander KP, Morin JF, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. Am J Cardiol, 2013, 111(1): 137-142.
13.	Navarro-García MA, Marín-Fernández B, de Carlos-Alegre V, et al. Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit. Rev Esp Cardiol, 2011, 64(11): 1005-1010.
14.	Zubrzycki M, Liebold A, Skrabal C, et al. Assessment and pathophysiology of pain in cardiac surgery. J Pain Res, 2018, 11: 1599-1611.
15.	Joseph HK, Whitcomb J, Taylor W. Effect of anxiety on individuals and caregivers after coronary artery bypass grafting surgery: a review of the literature. Dimens Crit Care Nurs, 2015, 34: 285-288.
16.	刘胜中, 丛伟, 甘崇志, 等. 体外循环心脏直视手术后并发精神障碍的临床分析. 中国胸心血管外科临床杂志, 2009, 16(1): 71-72.
17.	Contrada RJ, Boulifard DA, Idler EL, et al. Course of depressive symptoms in patients undergoing heart surgery: confirmatory analysis of the factor pattern and latent mean structure of the Center for Epidemiologic Studies Depression Scale. Psychosom Med, 2006, 68(6): 922-930.
18.	Patron E, Messerotti Benvenuti S, Palomba D. Preoperative and perioperative predictors of reactive and persistent depression after cardiac surgery: a three-month follow-up study. Psychosomatics, 2014, 55(3): 261-271.
19.	Drudi LM, Ades M, Turkdogan S, et al. Association of depression with mortality in older adults undergoing transcatheter or surgical aortic valve replacement. JAMA Cardiol, 2018, 3(3): 191-197.
20.	Borowicz L Jr, Royall R, Grega M, et al. Depression and cardiac morbidity 5 years after coronary artery bypass surgery. Psychosomatics, 2002, 43(6): 464-471.
21.	Lavie CJ, Menezes AR, De Schutter A, et al. Impact of cardiac rehabilitation and exercise training on psychological risk factors and subsequent prognosis in patients with cardiovascular disease. Can J Cardiol, 2016, 32(10 Suppl 2): S365-S373.
22.	Takagi H, Ando T, Umemoto T, et al. Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis. Heart Vessels, 2017, 32(12): 1458-1468.
23.	Kemp AH, Quintana DS, Gray MA, et al. Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry, 2010, 67(11): 1067-1074.
24.	Khandaker GM, Zuber V, Rees JMB, et al. Shared mechanisms between coronary heart disease and depression: findings from a large UK general population-based cohort. Mol Psychiatry, 2019. [Epub ahead of print.
25.	Goldston K, Baillie AJ. Depression and coronary heart disease: a review of the epidemiological evidence, explanatory mechanisms and management approaches. Clin Psychol Rev, 2008, 28(2): 288-306.
26.	Appelhans B, Luecken L. Heart rate variability as an index of regulated emotional responding. Review Gen Psych, 2006, 10: 229-240.
27.	Udupa K, Sathyaprabha TN, Thirthalli J, et al. Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures. J Affect Disord, 2007, 100(1-3): 137-141.
28.	Carney RM, Freedland KE, Stein PK, et al. Change in heart rate and heart rate variability during treatment for depression in patients with coronary heart disease. Psychosom Med, 2000, 62(5): 639-647.
29.	Thayer JF, Siegle GJ. Neurovisceral integration in cardiac and emotional regulation. IEEE Eng Med Biol Mag, 2002, 21(4): 24-29.
30.	Sforzini L, Pariante CM, Palacios JE, et al. Inflammation associated with coronary heart disease predicts onset of depression in a three-year prospective follow-up: a preliminary study. Brain Behav Immun, 2019, 81: 659-664.
31.	Suarez EC, Krishnan RR, Lewis JG. The relation of severity of depressive symptoms to monocyte-associated proinflammatory cytokines and chemokines in apparently healthy men. Psychosom Med, 2003, 65(3): 362-368.
32.	Richter B, Koller L, Hohensinner PJ, et al. Fractalkine is an independent predictor of mortality in patients with advanced heart failure. Thromb Haemost, 2012, 108(6): 1220-1227.
33.	张晓蕾, 赵永峰, 任岩春, 等. 冠心病患者焦虑和抑郁与炎症反应、血管内皮功能的关系. 中国循证心血管医学杂志, 2018, 10(2): 199-202.
34.	Tseng YL, Chiang ML, Huang TF, et al. A selective serotonin reuptake inhibitor, citalopram, inhibits collagen-induced platelet aggregation and activation. Thromb Res, 2010, 126(6): 517-523.
35.	Schins A, Honig A, Crijns H, et al. Increased coronary events in depressed cardiovascular patients: 5-HT2A receptor as missing link? Psychosom Med, 2003, 65(5): 729-737.
36.	Musselman DL, Marzec UM, Manatunga A, et al. Platelet reactivity in depressed patients treated with paroxetine: preliminary findings. Arch Gen Psychiatry, 2000, 57(9): 875-882.
37.	Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, 2008, 118(17): 1768-1775.
38.	冯雪, 袁洁, 李四维, 等. 比较两种测量方法对心脏外科手术术前患者焦虑和抑郁的评估结果. 中国循证心血管医学杂志, 2016, 8(11): 1386-1388, 1390.
39.	McVey Neufeld KA, Bienenstock J, Bharwani A, et al. Oral selective serotonin reuptake inhibitors activate vagus nerve dependent gut-brain signalling. Sci Rep, 2019, 9(1): 14290.
40.	Aaronson ST, Sears P, Ruvuna F, et al. A 5-year observational study of patients with treatment-resistant depression treated with vagus nerve stimulation or treatment as usual: comparison of response, remission, and suicidality. Am J Psychiatry, 2017, 174(7): 640-648.
41.	Sepehripour AH, Eckersley M, Jiskani A, et al. Selective serotonin reuptake inhibitor use and outcomes following cardiac surgery-a systematic review. J Thorac Dis, 2018, 10(2): 1112-1120.
42.	Ha JH, Wong CK. Pharmacologic treatment of depression in patients with myocardial infarction. J Geriatr Cardiol, 2011, 8(2): 121-126.
43.	金娟, 李志鸿, 邓晓威, 等. 参芪益心方联合运动康复对冠心病患者心理状态的影响. 中医药学报, 2017, 45(6): 110-112.
44.	亓国锋, 李刚刚, 李予春. 枣仁安神胶囊对冠心病伴焦虑和抑郁患者疗效及血清 5-HT、MPO 水平的影响. 中华中医药学刊, 2018, 36(3): 681-684.
45.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2011, 58: 2584-614.
46.	Tully PJ, Baker RA. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. J Geriatr Cardiol, 2012, 9(2): 197-208.
47.	Rost S, Van Ryckeghem DM, Koval P, et al. Affective instability in patients with chronic pain: a diary approach. Pain, 2016, 157(8): 1783-1790.
48.	Karavidas MK, Lehrer PM, Vaschillo E, et al. Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Appl Psychophysiol Biofeedback, 2007, 32(1): 19-30.

1. Modica M, Castiglioni P, Minotti A, et al. Psychological profile in coronary artery by-pass graft patients vs. valve replacement patients entering cardiac rehabilitation after surgery. Sci Rep, 2018, 8(1): 14381.
2. Liu J, Dong Q, Lu X, et al. Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder. J Affect Disord, 2020, 260: 91-96.
3. Stenman M, Holzmann MJ, Sartipy U. Association between preoperative depression and long-term survival following coronary artery bypass surgery--a systematic review and meta-analysis. Int J Cardiol, 2016, 222: 462-466.
4. Geulayov G, Novikov I, Dankner D, et al. Symptoms of depression and anxiety and 11-year all-cause mortality in men and women undergoing coronary artery bypass graft (CABG) surgery. J Psychosom Res, 2018, 105: 106-114.
5. Flaherty LB, Wood T, Cheng A, et al. Pre-existing psychological depression confers increased risk of adverse cardiovascular outcomes following cardiac surgery: a systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2017, 154(5): 1578-1586.
6. Poole L, Ronaldson A, Kidd T, et al. Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery. J Behav Med, 2017, 40(2): 249-258.
7. Hernández-Palazón J, Fuentes-García D, Falcón-Araña L, et al. Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: contributing factors and postoperative morbidity. J Cardiothorac Vasc Anesth, 2018, 32(1): 236-244.
8. Székely A, Balog P, Benkö E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study. Psychosom Med, 2007, 69(7): 625-631.
9. Tully PJ, Baker RA, Turnbull DA, et al. Negative emotions and quality of life six months after cardiac surgery: the dominant role of depression not anxiety symptoms. J Behav Med, 2009, 32(6): 510-522.
10. Açıkel MET. Evaluation of depression and anxiety in coronary artery bypass surgery patients: a prospective clinical study. Braz J Cardiovasc Surg, 2019, 34(4): 389-395.
11. Botzet K, Dalyanoglu H, Schäfer R, et al. Anxiety and depression in patients undergoing mitral valve surgery: a prospective clinical Study. Thorac Cardiovasc Surg, 2018, 66(7): 530-536.
12. Williams JB, Alexander KP, Morin JF, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. Am J Cardiol, 2013, 111(1): 137-142.
13. Navarro-García MA, Marín-Fernández B, de Carlos-Alegre V, et al. Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit. Rev Esp Cardiol, 2011, 64(11): 1005-1010.
14. Zubrzycki M, Liebold A, Skrabal C, et al. Assessment and pathophysiology of pain in cardiac surgery. J Pain Res, 2018, 11: 1599-1611.
15. Joseph HK, Whitcomb J, Taylor W. Effect of anxiety on individuals and caregivers after coronary artery bypass grafting surgery: a review of the literature. Dimens Crit Care Nurs, 2015, 34: 285-288.
16. 刘胜中, 丛伟, 甘崇志, 等. 体外循环心脏直视手术后并发精神障碍的临床分析. 中国胸心血管外科临床杂志, 2009, 16(1): 71-72.
17. Contrada RJ, Boulifard DA, Idler EL, et al. Course of depressive symptoms in patients undergoing heart surgery: confirmatory analysis of the factor pattern and latent mean structure of the Center for Epidemiologic Studies Depression Scale. Psychosom Med, 2006, 68(6): 922-930.
18. Patron E, Messerotti Benvenuti S, Palomba D. Preoperative and perioperative predictors of reactive and persistent depression after cardiac surgery: a three-month follow-up study. Psychosomatics, 2014, 55(3): 261-271.
19. Drudi LM, Ades M, Turkdogan S, et al. Association of depression with mortality in older adults undergoing transcatheter or surgical aortic valve replacement. JAMA Cardiol, 2018, 3(3): 191-197.
20. Borowicz L Jr, Royall R, Grega M, et al. Depression and cardiac morbidity 5 years after coronary artery bypass surgery. Psychosomatics, 2002, 43(6): 464-471.
21. Lavie CJ, Menezes AR, De Schutter A, et al. Impact of cardiac rehabilitation and exercise training on psychological risk factors and subsequent prognosis in patients with cardiovascular disease. Can J Cardiol, 2016, 32(10 Suppl 2): S365-S373.
22. Takagi H, Ando T, Umemoto T, et al. Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis. Heart Vessels, 2017, 32(12): 1458-1468.
23. Kemp AH, Quintana DS, Gray MA, et al. Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry, 2010, 67(11): 1067-1074.
24. Khandaker GM, Zuber V, Rees JMB, et al. Shared mechanisms between coronary heart disease and depression: findings from a large UK general population-based cohort. Mol Psychiatry, 2019. [Epub ahead of print.
25. Goldston K, Baillie AJ. Depression and coronary heart disease: a review of the epidemiological evidence, explanatory mechanisms and management approaches. Clin Psychol Rev, 2008, 28(2): 288-306.
26. Appelhans B, Luecken L. Heart rate variability as an index of regulated emotional responding. Review Gen Psych, 2006, 10: 229-240.
27. Udupa K, Sathyaprabha TN, Thirthalli J, et al. Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures. J Affect Disord, 2007, 100(1-3): 137-141.
28. Carney RM, Freedland KE, Stein PK, et al. Change in heart rate and heart rate variability during treatment for depression in patients with coronary heart disease. Psychosom Med, 2000, 62(5): 639-647.
29. Thayer JF, Siegle GJ. Neurovisceral integration in cardiac and emotional regulation. IEEE Eng Med Biol Mag, 2002, 21(4): 24-29.
30. Sforzini L, Pariante CM, Palacios JE, et al. Inflammation associated with coronary heart disease predicts onset of depression in a three-year prospective follow-up: a preliminary study. Brain Behav Immun, 2019, 81: 659-664.
31. Suarez EC, Krishnan RR, Lewis JG. The relation of severity of depressive symptoms to monocyte-associated proinflammatory cytokines and chemokines in apparently healthy men. Psychosom Med, 2003, 65(3): 362-368.
32. Richter B, Koller L, Hohensinner PJ, et al. Fractalkine is an independent predictor of mortality in patients with advanced heart failure. Thromb Haemost, 2012, 108(6): 1220-1227.
33. 张晓蕾, 赵永峰, 任岩春, 等. 冠心病患者焦虑和抑郁与炎症反应、血管内皮功能的关系. 中国循证心血管医学杂志, 2018, 10(2): 199-202.
34. Tseng YL, Chiang ML, Huang TF, et al. A selective serotonin reuptake inhibitor, citalopram, inhibits collagen-induced platelet aggregation and activation. Thromb Res, 2010, 126(6): 517-523.
35. Schins A, Honig A, Crijns H, et al. Increased coronary events in depressed cardiovascular patients: 5-HT2A receptor as missing link? Psychosom Med, 2003, 65(5): 729-737.
36. Musselman DL, Marzec UM, Manatunga A, et al. Platelet reactivity in depressed patients treated with paroxetine: preliminary findings. Arch Gen Psychiatry, 2000, 57(9): 875-882.
37. Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, 2008, 118(17): 1768-1775.
38. 冯雪, 袁洁, 李四维, 等. 比较两种测量方法对心脏外科手术术前患者焦虑和抑郁的评估结果. 中国循证心血管医学杂志, 2016, 8(11): 1386-1388, 1390.
39. McVey Neufeld KA, Bienenstock J, Bharwani A, et al. Oral selective serotonin reuptake inhibitors activate vagus nerve dependent gut-brain signalling. Sci Rep, 2019, 9(1): 14290.
40. Aaronson ST, Sears P, Ruvuna F, et al. A 5-year observational study of patients with treatment-resistant depression treated with vagus nerve stimulation or treatment as usual: comparison of response, remission, and suicidality. Am J Psychiatry, 2017, 174(7): 640-648.
41. Sepehripour AH, Eckersley M, Jiskani A, et al. Selective serotonin reuptake inhibitor use and outcomes following cardiac surgery-a systematic review. J Thorac Dis, 2018, 10(2): 1112-1120.
42. Ha JH, Wong CK. Pharmacologic treatment of depression in patients with myocardial infarction. J Geriatr Cardiol, 2011, 8(2): 121-126.
43. 金娟, 李志鸿, 邓晓威, 等. 参芪益心方联合运动康复对冠心病患者心理状态的影响. 中医药学报, 2017, 45(6): 110-112.
44. 亓国锋, 李刚刚, 李予春. 枣仁安神胶囊对冠心病伴焦虑和抑郁患者疗效及血清 5-HT、MPO 水平的影响. 中华中医药学刊, 2018, 36(3): 681-684.
45. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2011, 58: 2584-614.
46. Tully PJ, Baker RA. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. J Geriatr Cardiol, 2012, 9(2): 197-208.
47. Rost S, Van Ryckeghem DM, Koval P, et al. Affective instability in patients with chronic pain: a diary approach. Pain, 2016, 157(8): 1783-1790.
48. Karavidas MK, Lehrer PM, Vaschillo E, et al. Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Appl Psychophysiol Biofeedback, 2007, 32(1): 19-30.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress of anxiety and depression in adult patients undergoing cardiac surgery

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