Key result
Early postoperative anxiety is linked to greater subsequent fear of progression after cardiac surgery.
Why the study?
Patients following CABG frequently experience elevated anxiety and fear of progression, which are highly comorbid and increase adverse postoperative event risks, but their dynamic longitudinal associations remain unclear.
Observational (n=343)
Yes
Effect estimate: edge weight 0.34 (95% CI 0.07-0.61)
Anxiety symptoms decline but fear of progression intensifies during the early rehabilitation phase following CABG, suggesting a need for stage-specific psychological interventions.
Anxiety symptoms at discharge were associated with later fear of progression post-CABG; leaves open whether network-targeted interventions improve outcomes.
Background Patients following coronary artery bypass grafting (CABG) frequently experience elevated anxiety and fear of progression (FoP), which has a high comorbidity and significantly increases adverse postoperative event risks. This prospective study explored the dynamic longitudinal associations between anxiety and FoP in post-CABG patients using network analysis methods. Methods A prospective longitudinal design enrolled first-time CABG patients from three tertiary hospitals in Urumqi, China. Anxiety and FoP were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) at three time points: hospital discharge (T1), 1 month (T2), and 3 months (T3) post-discharge. Cross-sectional Gaussian Graphical Models were constructed at each time point, and cross-lagged panel network (CLPN) analysis was performed to examine longitudinal symptom associations. Six a priori selected covariates (age, gender, educational level, duration of CHD, chronic comorbidities, and NYHA functional classification) were residualized prior to network estimation. Results A total of 343 patients were included in the network analysis. From T1 to T3, total GAD-7 scores demonstrated a notable downward trend, whereas FoP-Q-SF scores exhibited a continuous upward trend. The core node at both T1 and T2 was FoP11 “Worrying about what will become of the family if something should happen to the patient, “ which shifted to FoP2 “Being nervous prior to doctors’ appointments or periodic examinations” at T3. In the T1-T2 CLPN, the strongest cross-lagged edge was from GAD7 “Feeling afraid as if something awful might happen” to FoP2 “Being nervous prior to doctors’ appointments or periodic examinations”. In the T2-T3 CLPN, the strongest cross-lagged edge was from GAD2 “Not being able to stop or control worrying” to FoP6 “Being afraid of the possibility that the children could contract disease”. In the T1-T3 network, the strongest cross-lagged edge was from GAD4 “Trouble relaxing” to FoP3 “Being afraid of pain”. Anxiety nodes generally exhibited higher Out-Expected Influence, while FoP nodes showed higher In-Expected Influence. Conclusion Anxiety levels gradually decreased during early rehabilitation, whereas fear of progression increased over time. Early anxiety symptoms showed positive cross-lagged associations with later fear of progression. These findings suggest that clinical nurses should consider phased, precision-based psychological interventions targeting stage-specific symptoms during different rehabilitation stages.
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Luo et al. (2026) conducted an observational in Coronary artery disease post-CABG (n=343). Anxiety symptoms was evaluated on Cross-lagged association from baseline anxiety (GAD7: Feeling afraid) to 1-month fear of progression (FoP2: Being nervous prior to appointments) (edge weight 0.34, 95% CI 0.07-0.61). Early postoperative anxiety symptoms showed strong positive cross-lagged associations with later fear of disease progression, notably from feeling afraid at discharge to being nervous about medical visits at 1 month (edge weight 0.34).
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