Effects of Mood Disturbance and Anxiety on CABG Outcomes Depression is an important risk factor for the development and progression of CAD. In fact, it is a more important predictor of the success of cardiac rehabilitation than many other functional cardiac variables.676 Both the presence of depressive symptoms before CABG and the postoperative worsening of these symptoms correlate with poorer physical and psychosocial functioning and poorer quality of life after CABG.677 In a study of 440 patients who underwent CABG, the effects of both preoperative anxiety and depression (as defined by the Depression Anxiety and Stress Scale) on mortality rate were assessed for a median of 5 years postop- eratively.678 Interestingly, preoperative anxiety was associ- ated with a significantly increased risk of death (HR: 1.88; sion was not.678 In a multivariate analysis of 817 patients at Duke University Medical Center, severe depression (assessed using the Center for Epidemiological Studies Depression scale before surgery and 6 months postoperatively665 was associated with increased risk of death (HR: 2.4; 95% CI: 1.4 to 4.0), as was mild or moderate depression that persisted at 6 months (HR: 2.2; 95% CI: 1.2 to 4.2). In another study of 309 subjects followed up for 1 year after CABG, those with diagnostic criteria for a major depressive disorder before discharge were nearly 3 times as likely to have a cardiac event, such as heart failure requiring hospitalization, MI, cardiac arrest, PCI, repeat CABG, or cardiac death.666 Fi- nally, depression after CABG is an important predictor of the recurrence of angina during the first 5 postoperative 4.8.2. 