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Longitudinal course of depressive, anxiety and post-traumatic stress disorder symptoms after heart surgery: a meta-analysis of 94 studies.

OBJECTIVE
To analyze the longitudinal course of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms in cardiac patients following heart surgery (HS).


METHODS
We conducted a systematic review and random-effects meta-analysis of cohort studies on patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days after. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken.


RESULTS
We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g=0.32; 95%CI=0.25,0.39; p<0.001) and anxiety improved after HS (g=0.52; 95%CI=0.43,0.62; p<0.001), while PTSD symptoms worsened (g=-0.42; 95%CI=-0.80,-0.04; p=0.032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure, and persisted over one year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension and dyslipidemia, and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was non-significant.


CONCLUSIONS
Depressive and anxiety symptoms improve over one-year after HS, while PTSD symptoms might worsen. Older patients, those with metabolic comorbidities, valve disease or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.