IDENTIFYING PSYCHOSOCIAL FACTORS INFLUENCING SHORT- AND LONG-TERM MORTALITY AND MORBIDITY AFTER ADULT CARDIAC SURGERY
Cserép Zsuzsanna
Cardiovascular Medicine and Research Division
Dr. Merkely Béla
SE Városmajori Szív- és Érgyógyászati Klinika
2025-03-26 14:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Székely Andrea
Dr. Varga János
Dr. Végh Tamás
Dr. Domján Gyula
Dr. Dósa Edit
Dr. Keltai Katalin
Dr. Sármán Balázs
In the MACCE study, we found that SRH, illness intrusiveness, depression, anxiety, sleeping disorders, social inhibition and negative affectivity, were independently associated with the occurrence of MACCE events after adjustment for biomedical factors and perioperative variables following cardiac surgery. We also demonstrated that severity of illness intrusiveness, sleeping problems and social inhibition increased in MACCE positive patients between 2 and 5 years, but did not change the event-free group. The MACCE positive group had higher BDI, STAI-S and T-test scores at baseline than the negative group, and this difference was maintained throughout the follow-up period. Both groups reported less social support at the end of year five. In our study, patients with Type D personality had more than 2 times the adjusted risk of adverse events at the end of the fifth year.
In the long term (7.5 years of follow-up after cardiac surgery), we found that STAI-T scores and low education levels were associated with a higher risk of mortality after adjustment for medical factors and MACCE after discharge. In accordance, higher education was associated with longer survival. We used additive EUROSCORE to estimate the risk of cardiac surgery. The risk model may be further refined including anxiety and education in relation to risk factors linked to higher mortality. The significance of preoperative anxiety screening in standard clinical practice is underscored by our findings.
We found that long operation time, high NYHA levels and severe COPD were significantly associated with an ICU stay equal to or longer than three days after cardiac surgery. After adjusting for medical factors, lower SRH and low happiness levels were also independently associated with length of ICU stay. Longer hospital stay was associated with the same clinical factors and female sex, but among psychosocial factors, only SRH remained a predictor after adjusting for depression and anxiety. The reliability of our risk model for ICU/prolonged hospital stay with medical factors could be improved by adding psychosocial factors: BDI, STAI-T, SRH and happiness.
