There is evidence that increased symptoms of psychological distress is a strong predictor of no change-deterioration trajectories in HRQoL and that this relationship is influenced by personality trait Type D. We conclude that mediating factors, especially increased anxiety and depression, should be treated adequately in post-CABG clinical routine.

Readers should be cautious when interpreting the results of clinical pathway evaluation studies because of the confounding factors and sources of contamination affecting the evidence-based validity of the outcomes.