European Heart Journal Open · Nov 7, 2026
Preoperative depression or anxiety and late new-onset atrial fibrillation after cardiac surgery - An observational cohort study
By Stenman M, Jackson V, Särnholm J et al.
Objectives: The aim was to study the association between preoperative depression or anxiety and incidence of late new-onset atrial fibrillation in patients undergoing cardiac surgery. Methods: Data from five national registers including 44 338 patients who underwent primary cardiac surgery in Sweden between 2006 and 2020 were used, excluding those with a prior diagnosis of atrial fibrillation. Follow-up for atrial fibrillation occurred >30 days after surgery. Cox regression models were used to estimate the association between preoperative depression or anxiety and new late-onset atrial fibrillation in the total study population, and according to sex and age categories. Results: In total, 1037 (12%) of the patients with preoperative depression or anxiety, and 5036 (14%) of those without, developed late new-onset atrial fibrillation following cardiac surgery. Patients with depression or anxiety had an increased risk of developing atrial fibrillation after cardiac surgery (adjusted hazard ratio (aHR) 1.09; 95% confidence interval (CI) 1.01-1.17). Sex specific analysis showed that men with depression or anxiety had an increased risk of late new-onset atrial fibrillation (aHR 1.14; 95% CI 1.05-1.25), whereas this increased risk was not observed in women (aHR 1.00; 95% CI 0.89-1.13). Conclusions: Patients with preoperative depression or anxiety undergoing primary cardiac surgery had an increased risk of late new-onset atrial fibrillation. This association was predominantly observed in men under 75 years of age. Routine screening for depression and anxiety, can identify patients at-risk. Comprehensive care, including mental health support, lifestyle changes and medication management, may reduce the risk of late new-onset atrial fibrillation.