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The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery

Zsuzsanna Cserép1, Eszter Losoncz2, Piroska Balog3, Tamás Szili-Török4, András Husz1, Boglárka Juhász4, Miklós D Kertai1, János Gál1 and Andrea Székely15*

Author Affiliations

1 Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, H-1085, Hungary

2 University of Szeged, Szeged, H-6720, Hungary

3 Institute of Behavioral Sciences, Semmelweis University, Budapest, H-1085, Hungary

4 Department of Cardiac Surgery of Gottsegen György Hungarian Institute of Cardiology, Budapest, H-1096, Hungary

5 Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Haller u. 29, Budapest, H-1096, Hungary

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Journal of Cardiothoracic Surgery 2012, 7:86  doi:10.1186/1749-8090-7-86

Published: 14 September 2012



Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery.


After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths.


During a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained.


Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.

Mortality; Cardiac surgery; Anxiety; Depression; Education