May 13, 2010Journal of Cardiothoracic SurgeryOpen Access

Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary heart disease and depression (n=362). Intervention: Comorbid depression and coronary heart disease vs. Coronary heart disease without depression. Primary outcome: Non-routine discharge following CABG surgery (OR 1.43, 95% CI 1.33-2.63, p=<0.05).

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Key result

Comorbid depression and coronary heart disease significantly increased the odds of non-routine discharge following CABG surgery compared to coronary heart disease alone (OR 1.43).

Why the study?

Does depression and autonomic nervous system dysregulation predict worse in-hospital outcomes in patients undergoing CABG?

Study Design

Type

Observational (n=362)

Multicenter

Yes

Structured PICO

Does depression and autonomic nervous system dysregulation predict worse in-hospital outcomes in patients undergoing CABG?

Population

362 male patients categorized by the presence of coronary heart disease and depression, with 180 CABG patients assessed for autonomic dysregulation and surgical outcomes.

Exposure

Diagnosis of major depressive disorder (MDD) and presence of autonomic nervous system dysregulation (measured by heart rate, heart rate variability, and plasma norepinephrine).

Comparator

Patients without depression, patients without CHD, and patients with neither condition.

Outcome

In-hospital length of stay (days) and patient disposition (routine vs. non-routine discharge).

Main Result

Odds Ratio: 1.43 (95% CI 1.33–2.63)

p-value: p=<0.05

In male patients undergoing CABG, comorbid depression and autonomic nervous system dysregulation (elevated heart rate and reduced heart rate variability) are independent predictors of longer hospital stays and non-routine discharge.

Limitations

Extraneous variables such as number of grafts and medications were not controlled for
Reliability of diagnoses using multiple raters was not assessed
Generalizability is limited because the study included only male patients without comorbid psychiatric disorders
HRV was calculated using short-term SDNN rather than 24-hour ambulatory monitoring
Extraneous variables that might inflate systematic error (e.g., number of grafts, medications) were not controlled for.
Did not assess reliability of psychiatric diagnoses using multiple raters.
Limited generalizability because the study had only male patients and excluded patients with comorbid psychiatric disorders.
Used short-term HRV (SDNN) instead of 24-hour ambulatory monitoring and frequency domain indices.

Discussion

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Implication

May inform preoperative risk stratification in CABG; leaves open whether depression treatment improves discharge outcomes.

Cite This Study

Dao et al. (2010) conducted an observational in Coronary heart disease and depression (n=362). Comorbid depression and coronary heart disease vs. Coronary heart disease without depression was evaluated on Non-routine discharge following CABG surgery (OR 1.43, 95% CI 1.33-2.63, p=<0.05). Comorbid depression and coronary heart disease significantly increased the odds of non-routine discharge following CABG surgery compared to coronary heart disease alone (OR 1.43).

synapsesocial.com/papers/6a97f29bd08ffd74dfc638aa https://doi.org/10.1186/1749-8090-5-36

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Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider