Effects of Preoperative Psychological Interventions on Catecholamine and Cortisol Levels After Surgery in Coronary Artery Bypass Graft Patients: The Randomized Controlled PSY-HEART Trial.

OBJECTIVE: To examine whether preoperative psychological interventions targeting patients' expectations are capable of influencing the biological stress response after coronary artery bypass graft (CABG) surgery and could thus improve recovery after heart surgery.

METHODS: Randomized controlled trial with assessments 10 days before surgery, post-psychological intervention (day of hospital admission, but before surgery), postoperative (6-8 days later) and at follow-up (6 months after surgery). Eligible patients (N=124) scheduled for elective on-pump CABG or CABG with valve replacement surgery were approached before hospital admission. Standard medical care (SMC) was compared to two additional preoperative psychological interventions: a) an expectation manipulation intervention (EXPECT) to optimize patients' expectations about course and outcomes, or b) supportive therapy (SUPPORT), containing the same amount of therapeutic attention, but without specifically focusing on expectations. Postoperative plasma adrenaline, noradrenaline and cortisol levels were a secondary outcome of our study (primary outcome patients' disability 6 months after surgery and other secondary patient-reported or clinical outcomes were reported elsewhere).

RESULTS: EXPECT (3.68 ln pg/ml, 95% CI 3.38-3.98; p=.015) and SUPPORT (3.70 ln pg/ml, 95% CI 3.38-4.01; p=.026) led to significantly lower postoperative adrenaline levels compared to SMC (4.26 ln pg/ml, 95% CI 3.99-4.53) only. There were no treatment effects of the preoperative intervention for noradrenaline (p=.90) or cortisol (p=.30). Higher postoperative adrenaline levels predicted disability 6 months after surgery (r=.258, p=.018).

CONCLUSIONS: In addition to standard medical care, preoperative psychological interventions seem to buffer psychobiological stress responses and could thus facilitate recovery from CABG surgery. Patients' postoperative stress responses could be an important factor for explaining trajectories of long-term outcomes.

TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01407055).