Psychological Preparation for Cardiac Surgery
Open accessAbstract
Purpose of Review: To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. Recent Findings: Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients’ preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients’ knowledge or social support and to modify and optimize expectations and illness beliefs. Summary: Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients’ psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.
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Social support is an important factor for especially post-operative anxiety.
“As social support is an important factor for especially post-operative anxiety (Salzmann et al., 2020), we also wanted to explore whether social support as experienced by the patients differed between postponed and nonpostponed patients.”
From Postponement of elective cardiac surgery: A prospective observational analysis of anxiety, depression, social support and clinical complications. (2023) · cites this paper as Salzmann et al., 2020
The “Providing Psychosocial Support” section reports that an intervention combining emotional support with individualized information reduced both preoperative and postoperative anxiety in CABG patients. It does not isolate social support as the factor responsible or show that its importance is greater for postoperative anxiety. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPreoperative psychological preparation may reduce negative effects on post-operative outcome by optimising expectations and illness beliefs.
“In a recent review, Salzmann et al. (2020) found that preoperative psychological preparation, for example improving knowledge and social support, may be able to reduce negative effects on post-operative outcome by optimising expectations and illness beliefs.”
From Postponement of elective cardiac surgery: A prospective observational analysis of anxiety, depression, social support and clinical complications. (2023) · cites this paper as Salzmann et al. (2020)
Increasing social support pre-surgery may be protective against psychological distress related to surgery.
“increasing social support pre-surgery may be protective against psychological distress related to surgery (Salzmann et al., 2020)”
From Postponement of elective cardiac surgery: A prospective observational analysis of anxiety, depression, social support and clinical complications. (2023) · cites this paper as Salzmann et al., 2020
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BackgroundCruzado, J. A., Martínez-García, V., González, I. P., Gutiérrez, V., Jarabo-Sarceda, J. R., Calatayud-Gastardi, J., Teresa, L. D. V., Fernández-Martín, E., Gómez-Martínez, A., & Hernando-Trancho, F. (2021) · Cirugia Española · doi:10.1016/j.ciresp.2021.03.010 · Cited by 3 · see citing works
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Acute kidney injury after lung transplantation: prediction, prevention, and management
Ye, C.-Y., Huang, J., Ye, T., Ke, L., Jiang, X., & Zhu, C. (2025) · Renal Failure · doi:10.1080/0886022x.2025.2600121 · Cited by 2
“…stream-line the preparation process, ensuring that patients receive timely and appropriate instructions regarding their surgical procedure [29]. additionally, psychological preparation is gaining recognition for its impact on surgical outcomes, as addressing patients’ anxieties and…”
Salzmann, S., Stenzel, K. L., Sadlonova, M., Euteneuer, F., Horn, N., Rastan, A. J., Lenz, J., Böning, A., Salzmann-Djufri, M., Niemann, B., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-93467-7 · Cited by 4 · see citing works
“This finding is consistent with other work suggesting that patients’ illness beliefs and expectations before cardiac surgery predict outcomes after cardiac surgery independent of objective medical risk factors 7,25,60 .”
Self-citationClinical experience with medical hypnosis as an adjunctive therapy in heart surgery
Tigges-Limmer, K., Brocks, Y., Winkler, Y., Stock-Gissendanner, S., & Gummert, J. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1356392 · Cited by 2 · see citing works
“…predominant stressors and their common presentations of distress during the surgery process vary across three phases of hospital care: initial assessment and admission, shortly before and during the operation, and immediately after surgery (Tigges-Limmer et al., 2019; Salzmann et al., 2020).”
Backgroundde Lima, A. V., de Melo, V. L., da Silva, I. P., Lucena, S. K. P., da Silva, B. W. A. C., de Sena, J. F., & Costa, I. (2024) · Revista Gaúcha de Enfermagem · doi:10.1590/1983-1447.2024.20230186.pt · Cited by 2
Salzmann, S., Euteneuer, F., Domroese, R., Boeken, U., Lichtenberg, A., Dinger, U., Zimmermann, C., Neumann, M., Schäfer, R., & Markser, A. M. (2026) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2026.101306 · Cited by 1 · see citing works
“Accumulating evidence indicates that such psychological factors may meaningfully shape postoperative recovery (Salzmann et al., 2020), and mental comorbidity in cardiac patients has been linked to longer hospital stays and more complicated courses (Carter et al., 2016).”
Self-citationDizdar, E., Kılıç, A., Kayhan, S. A., Çilingir, D., & Turhan, Ş. B. (2026) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000721 · Cited by 1 · see citing works
“Before surgery, surgical patients often experience physical and psychological conditions such as anxiety, uncertainty, fear, depression, worry about the outcome of the surgery, and pain (Ramesh et al., 2017; Salzmann et al., 2020).”
Wang, Y., Liu, W., & Lin, L.-X. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1628394 · Cited by 1 · see citing works
CARDIAC PREHABILITATION: IS THERE A ROLE IN CARDIAC SURGERY
Giambattista, C. D., Buyck, K., & Shepherd, S. (2025) · Best Practice & Research Clinical Anaesthesiology · doi:10.1016/j.bpa.2025.08.008 · Cited by 1 · see citing works
Gül, S., & Yalcinturk, A. A. (2025) · Journal of Perianesthesia Nursing · doi:10.1016/j.jopan.2025.01.015 · Cited by 1 · see citing works
Özdemir, F. E., & Yılmaz, M. (2024) · Türk hemşireler derneği dergisi. · doi:10.70479/thdd.1401780 · Cited by 1 · see citing works
Jaworska, I., Pudlo, R., Mierzyńska, A., Kuczaj, A., Piotrowicz, E., Biełka, A., & Przybyłowski, P. (2024) · Psychiatria Polska · doi:10.12740/pp/170067 · Cited by 1 · see citing works
Empathetic Mental Health Systems for All: Experiential Insights as a Prosumer
Viswanathan, P. (2024) · Journal of Psychosocial Rehabilitation and Mental Health · doi:10.1007/s40737-024-00402-6 · Cited by 1 · see citing works
“…has been highlighted to be important for various general medical as well as post-operative outcomes, not just in psychiatric treatment, but various forms of treatment for physiological disorders as well, ranging from cardiac surgery to breast cancer (Salzmann et al., 2020; van Vliet et al., 2019).”
Ho, C. L. B., Brennan, A., Dinh, D., Lefkovits, J., Liew, D., Si, S., Reid, C., & Norman, R. (2022) · Applied Research in Quality of Life · doi:10.1007/s11482-022-10071-x · Cited by 1
“…- - 0.32 0.31 0.31 Anxiety/depres- sion EF ≥ 50% (n = 13,122) 15.4 15.8 1.25 (1.01–1.54) 1.25 (1.01–1.54) 1.24 (1.00–1.53) EF < 50% (n = 6556) 17.4 17.8 1.11 (0.86–1.43) 1.11 (0.86–1.43) 1.08 (0.84–1.39) p for interaction - - 0.68 0.92 0.90 1 3 (Neumann et al., 2019b; Salzmann et al., 2020).”
InfluentialKılınç, T., Yayla, A., & Erğün, A. (2026) · BMC Psychology · doi:10.1186/s40359-026-05697-7
“Although open-heart surgery is vital for patients, it creates high levels of physical, psychological, and emotional stress, such as anxiety, fear, depression, and pain [2].”
Syawalani, M. S., Pramita, E. S., & Purnamasari, V. (2026) · Genius Journal of Medical Surgical Nursing · doi:10.66763/gjmsn.v1i2.40
“Consequently, preoperative preparation for patients receiving spinal anesthesia should address not only physical suitability and procedural safety but also psychological readiness and person-centered support (Haddad et al., 2024; Leonardsen et al., 2024; Salzmann et al., 2020).”
Jiang, S.-J., Pang, Y., Wei, H., Yan, M., & Dong, X.-T. (2026) · Journal of Pain Research · doi:10.2147/jpr.s610392
Adaptive Responses and Stress Coping Styles in Cardiac Surgery Patients: A Clinical Study
Wąchol, G., & Tokarczyk, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15134909
Salzmann, S., Salzmann-Djufri, M., & Wilhelm, M. (2026) · Kardiologie up2date · doi:10.1055/a-2755-8438
Self-citationSituational Breath Control of Patients in Cardiac Surgical Rehabilitation
Arkhipova, N. V., & Bykov, E. V. (2026) · Journal of Medical and Biological Research · doi:10.37482/2687-1491-z285
Sever, S., Üzel, Z., Aydemir, E., & Duyğun, C. (2026) · Medical Records · doi:10.37990/medr.1792950
Patients' Experience Before Cardiac Surgery During the COVID‐19 Pandemic: A Qualitative Study
Ahmetbegovic, M., Bramhagen, A., Huseinagić, H., & Vejzović, V. (2026) · Nursing Open · doi:10.1002/nop2.70423
Hamzah, S. A., Daud, A., Jamaludin, T. S., Mokhtar, H. H. M., & Haron, Z. (2025) · INTERNATIONAL JOURNAL OF CARE SCHOLARS · doi:10.31436/ijcs.v8i3.337
Patient Experiences after Open Heart Surgery: A Qualitative Systematic Review
Kaya, H., Lumprom, O., Schofield, P., Carey, M., & Latour, J. M. (2025) · Florence Nightingale Journal of Nursing · doi:10.5152/fnjn.2025.24294
“Spiritual care should be included in care and support programmes that are integrated with individual preferences and cultural contexts to improve resilience during recovery.”
Lonsako, D. T., Geda, B., Gobena, T., Kechine, T., Wolde, Y., & Samuel, S. (2025) · Discover Health Systems · doi:10.1007/s44250-025-00274-y
“Preoperative patient care helps patients understand and prepare physically and mentally for surgical procedures and recovery in the postoperative period [1].”
Compère, V. N., Balci, S., Heinz, C., Schade‐Brittinger, C., Rastan, A. J., Salzmann-Djufri, M., Niemann, B., Boening, A., Choi, Y., Zarski, A., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-092482
Self-citationIntervenção psicológica no preparo pré-cirúrgico em crianças com cardiopatias congênitas
Espíndola, P. D., & de Montalvão, T. C. (2025) · Cuadernos de Educación y Desarrollo · doi:10.55905/cuadv17n5-107
Göçer, S., Artiran, M., Ilkeli, E., & Sapancı, A. (2025) · International Journal of Artificial Organs · doi:10.1177/03913988251331469
“17 However, more research is needed to find out how to help individuals and to understand why some methods work better than others.”
From Sheep to Heart: A Case of Infective Endocarditis due to Coxiella Burnetii
Lungu, A., Boarescu, P.-M., Siriopol, D., Terteliu-Băiţan, M., Gavril, R., & Mitu, F. (2024) · Internal Medicine · doi:10.2478/inmed-2024-0313
Santoso, T., Junait, & Fatmawati, E. (2024) · Babali Nursing Research · doi:10.37363/bnr.2024.53401
“Furthermore, previous studies have indicated that patients scheduled for cardiovascular surgery exhibit disrupted sleep patterns [3], [8].”
BackgroundIakovleva, M., Provotorova, J., Sheremet, A., Shmatov, D., Kamenskikh, M., Efremov, S., & Shchelkova, O. (2024) · Siberian Journal of Clinical and Experimental Medicine · doi:10.29001/2073-8552-2024-39-2-133-140
Karimzadeh, Z., Aliakbari, F., Salehi, S., & Raeisi, H. (2023) · Journal of Multidisciplinary Care · doi:10.34172/jmdc.1170
“Lack of knowledge and uncertainty is associated with preoperative anxiety, so a method to reduce preoperative tension is to provide information or education to patients before the operation (24).”
BackgroundMethodMankovskyi, D. (2023) · Ukrains'kyi Visnyk Psykhonevrolohii · doi:10.36927/2079-0325-v31-is1-2023-7
Mankovskyi, D. (2022) · Ukrains'kyi Visnyk Psykhonevrolohii · doi:10.36927/2079-0325-v30-is2-2022-3
Cruzado, J. A., Martínez-García, V., González, I. P., Gutiérrez, V., Jarabo-Sarceda, J. R., Calatayud-Gastardi, J., Teresa, L. D. V., Fernández-Martín, E., Gómez-Martínez, A., & Hernando-Trancho, F. (2022) · Cirugia Española · doi:10.1016/j.cireng.2022.06.014
Kazitani, B. S., Martins, L. M., da Silva, V. M., Fernandes, P., Maier, S. R. D. O., & Dessotte, C. A. M. (2023) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2022-0250pt
- Authors
- Salzmann, S., Salzmann-Djufri, M., Wilhelm, M., & Euteneuer, F.
- Affiliations
- Philipps University of Marburg (DE)
- Universitätsklinikum Gießen und Marburg (DE)
- Corresponding author
- Salzmann, Stefan
- Venue
- Current Cardiology Reports
- Published
- 2020-10-10
- Volume
- 22
- Issue
- 12
- Pages
- 172-172
- ISSN
- 1523-3782 (ISSN-L)
- 1534-3170
- PMC
- PMC7547964
- OpenAlex
- W3092239502
- Cited by
- 72
- References
- 76
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 18 · 2023: 14 · 2022: 14 · 2021: 3
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Current Cardiology Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Funders
- Deutsche Forschungsgemeinschaft (Ri 574 21–1, Ri 574/29-1)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- preoperative psychological preparation, cardiac surgery, preoperative anxiety, psychosocial factors, postoperative outcomes, social support, illness beliefs, patient expectations, patient knowledge, quality of life, postoperative complications
- MeSH terms
- Cardiac Surgical Procedures, Humans, Quality of Life
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