Distinct Longitudinal Trajectories of Anxiety and Depression Following Coronary Artery Bypass Grafting and Their Associations With Hospital Readmission: A 24-Month Prospective Cohort Study Publisher



Mohammadabadi A ; Mardani A ; Rahimkhani M ; Askari M
Source: Perioperative Care and Operating Room Management Published:2026

Abstract

Background: Anxiety and depression are common after coronary artery bypass grafting (CABG) and are linked to worse clinical outcomes. Most studies use single time-point measures; trajectory-based approaches may better identify patients at risk of adverse events. We examined 24-month longitudinal trajectories of anxiety and depression after CABG and their associations with hospital readmission, and tested whether demographic factors predict trajectory membership. Methods: In this prospective cohort, 114 elective CABG patients were enrolled and 98 (85.9%) completed 24-month follow-up. State anxiety (STAI-S) and depressive symptoms (BDI-SF) were assessed preoperatively and at 3, 6, 12 and 24 months. Group-based/clustering trajectory modeling identified longitudinal patterns. Multinomial logistic regression tested demographic predictors (age, sex, BMI, marital status, education) of trajectory membership. Adjusted logistic regression models evaluated associations between trajectory groups and cardiac-related hospital readmission at 12 and 24 months (models adjusted for the same demographic covariates). Results: Three trajectories emerged for both constructs. Anxiety: Increasing (n=44, 44.9%), High–persistent (n=36, 36.7%), Improving (n=18, 18.4%). Depression: Low–stable (n=50, 51.0%), High–persistent (n=31, 31.6%), Increasing (n=17, 17.3%). Older age and lower educational attainment predicted membership in adverse anxiety trajectories (each year increase in age: OR=1.14, 95% CI 1.04–1.25 for Increasing; OR=1.22, 95% CI 1.09–1.37 for High–persistent; higher education protective vs. High–persistent: OR=0.35, 95% CI 0.12–0.99). Demographic variables did not significantly predict depression trajectories. Trajectory–readmission associations differed by domain: High–persistent depression was associated with increased 12-month readmission risk (OR=2.89, 95% CI 1.01–8.29; p=0.049), whereas membership in the Increasing anxiety trajectory was associated with markedly lower odds of readmission at 12 months (OR=0.10, 95% CI 0.03–0.50; p=0.003) and 24 months (OR=0.08, 95% CI 0.02–0.37; p=0.001). Male sex independently predicted lower 24-month readmission (OR=0.22, 95% CI 0.07–0.67; p=0.008). Conclusion: Post-CABG psychological recovery is heterogeneous. Trajectory membership—particularly persistent depression and rising anxiety—carries distinct prognostic implications for hospital readmission. Demographic factors (age, education) influence clinical risk indirectly via their effects on anxiety trajectories. Trajectory-informed monitoring and targeted interventions may improve post-CABG outcomes beyond what single time-point screening can achieve. © 2026 Elsevier Inc.