Repairing a Broken Heart: Why You Should Pay Attention to Post-Operative Depression with CABG Patients
While your patient is recovering from Coronary Artery Bypass Grafting (CABG), you’re likely monitoring them for physical signs and symptoms that may require intervention. However, a patient’s mental health can play a vital role in their recovery and whether they recover without incident.
Post-surgical Depression is a common occurrence. In fact, depression is so common after heart surgery it has its own name -- cardiac depression. Following are some interesting facts and observations about how your patients’ mental health can impact their surgical recovery and what you can do to help.
Depression and Heart Surgery
Depression has a link to heart health, according to the American Heart Association (AHA). The AHA notes that depressed patients have a higher stress response. Stress releases higher levels of cortisol and cortisol can negatively affect heart health.
Depressed patients may also have uncontrolled high blood pressure or higher amounts of inflammation, which can also harm heart health.
But how does depression impact patients who already have a heart problem or who have undergone a surgical procedure?
Cardiac depression impacts about 25% of patients who have had a heart procedure or heart event like a heart attack. However, patients who have undergone CABG are 30-40% more likely to have depression.
Patients can become depressed after heart surgery for a number of reasons including:
- 1. Having to face their mortality
- 2. Concerns about recovery
- 3. Coping with feelings of inadequacy
- 4. Concerns about the future
- 5. Feeling guilty about depending on others for care or help
- 6. Concerns that the surgery may not help
- 7. Financial or logistical concerns about the procedure
CABG patients are at higher risk for depression because despite the success of the procedure, the outcome can still be disappointing. Depressed CABG patients are also more likely to have postoperative delirium, unplanned admissions and cardiac events.
Postoperative CABG patients were studied by Doering, et al and they found that at six weeks, post hospital discharge patients with depression had more infections, poor wound healing, lower quality of life and poor emotional and physical recovery.
Complications of Post-Surgery Depression
Depression following surgery can have a real impact on how a patient recovers. According to Ghoneim, et al, psychological stress induces an inflammatory response in the body. Many studies have shown an increased rate of post-surgical infections in patients who suffered from depression after CABG.
In older patients who undergo a surgical procedure, the risk of postoperative cognitive impairment is high. Postoperative cognitive impairment is a side effect of anesthesia.
Postoperative delirium is another complication common among patients aged 65 and older. The risk of this complication rises if the patient is also depressed.
Abrams, et al found that anxiety and depression increased the risk of death for surgical patients admitted to the ICU.
Screening Your Postoperative Patients for Mental Health
Despite the prevalence of cardiac depression, many patients and clinicians are unaware of its existence. It is, however, relatively easy to screen your patients for it. Consider using the Patient Health Questionnaire-9 to check your postoperative and preoperative patients’ level of depression.
In conjunction with the questionnaire, open conversations with patients to help them understand post-op cognitive impairment and the realities and risks of cardiac depression can help the patient to prepare themselves in advance.
If a patient screens positive for depression, either pre- or post-operatively, this can be a great opportunity to set up a care plan to help mitigate some of the negative physical effects of depression after surgery. Including a psychiatrist and/or a psychologist on the patient’s treatment team to develop a formal treatment plan can go a long way in helping the patient avoid the negative ramifications of undiagnosed depression.