Heart of the Matter: psychological health after bypass graft surgery
Research type
Research Study
Full title
Heart of the Matter: cohort study investigating psychological health in patients who have coronary artery bypass graft surgery (CABG).
IRAS ID
305795
Contact name
Francesca Leone
Contact email
Sponsor organisation
Hull University Teaching Hospitals
Duration of Study in the UK
2 years, 0 months, 31 days
Research summary
Summary of Research
The “Adult cardiac (heart) surgery research group” in 2019 outlined post-surgical quality of life, including mental preparation for surgery as a priority for researchers. Surgery itself can be considered a traumatic event, especially if the operation was the result of an emergency. Pre-surgical mental preparation has been well studied to date. However, in emergency surgery the pre-surgery phase is extremely short or non-existent. There are little to no studies on the use of mental optimisation around the time of the operation in emergency surgical patients. Historically, where mental health care has been employed around the time of surgery there has been demonstrable benefit in the overall quality of life of patients in the immediate and follow up periods. Studies indicate that surgical patients find this type of care beneficial to their rehabilitation, revealing the emotional impact of surgery to be key in-patient centred care. If looking particularly at heart surgery patients, those admitted for emergency bypass grafts after a heart attack are at particular risk of developing a mental health condition. After a heart attack, patients are three times more likely to suffer from depression than the general population.
We want to investigate patients between 18-89 years old undergoing both elective and urgent isolated bypass grafts within Hull University Teaching Hospitals. We will distribute questionnaires looking at anxiety, depression and traumatic stress pre-operation, 6 weeks and 6 months after surgery. We will so perform interviews to assess the impact of surgery on mental health and recovery in a smaller group of patients. With this data we will identify whether urgent surgical patients in this population need better inpatient support to improve their mental health post-surgery. We hope that this will lead to more research aiming to improve the service in this area.Summary of Results
There were two parts of this study, a questionnaire study and an interview study. We gave questionnaires to participants undergoing heart surgery on the elective and urgent pathways which asked about symptoms of depression, anxiety and post-traumatic stress disorder pre-operatively, at 6 weeks post-op and 6 months post-op. 104 participants completed the study, 61 elective participants and 43 from the urgent pathway. We found no statistically significant difference in depression between electives and urgent patients at any timepoint but the prevalence of depression was higher than the national average in both groups at all timepoints, except in the urgent population at 6 months. Anxiety was significantly higher in the urgent population than in the elective population preoperatively with 48.8% displaying symptoms of anxiety. The prevalence of anxiety was higher than the national average in both groups at all points; while anxiety reduced in the urgent population by 6 months, it increased in the elective population in comparison to the preoperative baseline. There was no statistically significant difference between the prevalence of post-traumatic stress disorder symptoms in the urgent population in comparison to the elective population.
The interview study tried to understand the experience of undergoing heart surgery. We interviewed 20 participants, 6 months after their cardiac surgery. There were three main themes through the interviews irrespective of whether patients were on the urgent or elective pathway. 1. Changing self: How people perceive themselves before and after an operation changes; it is characterised by coping with loss of health, confronting mortality and creating a new sense of self in recovery. The latter may or may not meet expectations and can be complicated by both internal and external factors. 2. Communication: The impact of communication with healthcare professionals at all stages impacts how the patient experiences their illness, their surgery and their recovery. The importance of timely follow-up, reassurance and tailored education was emphasised by the study groups. 3. The Support System: Participants received support from a variety of sources both formal and informal. Familial support was exceedingly important in the recovery phase for patients post-operatively. Where systemic failure contributed to a breakdown in support structures this was a source of distress and in some cases trauma for the participants in this study.REC name
West of Scotland REC 4
REC reference
22/WS/0005
Date of REC Opinion
1 Feb 2022
REC opinion
Further Information Favourable Opinion