Anxiety and Depression as Predictors of Cardiovascular Outcomes After Cardiac Surgery




We read the article by Williams et al, who curiously suggest that the relation between pre-existing anxiety and cardiac surgery outcomes has not been clearly defined, in fact referring to a past “ failure to consider depression and anxiety simultaneously. ” Putting the alleged “ past failure ” in appropriate context, several studies published during the past 6 years have elucidated the simultaneous role of anxiety and depression with respect to various cardiac surgery outcomes. Overlooking previous studies would not be so conspicuous had Williams et al used a questionnaire other than the Hospital Anxiety and Depression Scale (HADS). A recent factor analysis has shown that the HADS does not clearly distinguish depression from anxiety, questioning the extent to which anxiety and depression were independently measured. A final limitation of previous research highlighted by Williams et al was the sample size and, presumably, insufficient statistical power. Most of these cited studies had sample sizes approximate to, or larger than, that in the study by Williams et al. In fact, the study by Williams et al provides a suitable exemplar of insufficient statistical power in relation to the morbidity event rate that is reflected in the extraordinarily large confidence intervals spanning a 1- to 20-fold morbidity risk of HADS anxiety scores >11 (odds ratio 5.1, 95% confidence interval 1.27 to 20.2). In conclusion, the limitations of the HADS construct validity, the width of the confidence interval for anxiety, and the lack of any clear hypothesis suggests that the study by Williams et al will not overcome previous limitations or markedly add to understanding of the role of anxiety on cardiac surgery outcomes as was claimed.


References



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Dec 7, 2016 | Posted by in CARDIOLOGY | Comments Off on Anxiety and Depression as Predictors of Cardiovascular Outcomes After Cardiac Surgery

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