Colleagues of Dr. Nabil El Sanadi saw no signs that the Broward Health CEO was suffering from depression as a result of his recent triple bypass surgery.
“He was worried about everybody else, asking how members of his senior team were doing, asking how the hospital volumes were, and looking toward the future,” said Mark Sprada, vice president and chief nursing officer for Broward Health.
Others held the same view of El Sanadi, who they described as an energetic, charismatic leader focused on improving health outcomes for patients and the community at large.
“He was always available to any community member who had a concern or who had a family member who needed to go to the hospital,” said Charlotte Mather-Taylor, Broward Health vice president of government relations. “It didn't matter the time of day or night, he was always there for people.”
Sprada said he spent time with El Sanadi each day after his surgery and described his mood and personality as unchanged from the one he knew prior to his procedure. “His demeanor pre-operatively in terms of being positive ... did not change post-operatively,” Sprada said.
Sprada and others said they saw no evidence El Sanadi was suffering from any ill effects in the 10 days following his surgery. El Sanadi, 60, died Saturday as a result of a self-inflicted gunshot wound, according to Broward County investigators.
But others have commented to the local newspaper, the Sun Sentinel, and in its online condolence page, that El Sanadi, known to return phone calls or texts within a day, was unresponsive in the days before his death. One colleague emotionally admitted that if he had to guess, El Sanadi's health issues would have played a factor in his suicide.
No clear connection has yet been made. But evidence has found patients who undergo such procedures have been known to experience impaired cognitive function as well as depression.
Estimates vary as to the number of heart patients who are thought to experience depression after undergoing surgery. Depression has been linked to increased risk for worse health outcomes among cardiac surgery patients, which can lead them to be less active or more likely to drop their medications.
According to the American College of Cardiology, as many as 20% of people hospitalized with a heart attack report symptoms of depression, with heart disease patients being three times more likely to develop depression compared with the general population.
Yet the online information regarding coronary artery bypass graft surgeries at Broward Health, where El Sanadi had his own surgery, does not warn patients of possible cognitive side effects and does not ask them to report changes in emotional or mental status to their cardiologists or primary physicians.
A connection between the two conditions seems often to be a missing link.
“For a few years now it's been recommended to screen patients with heart disease for depression,” said Dr. Wanda Filer, president of the American Academy of Family Physicians. “But also we know that in patients with depression, they have a higher risk of heart disease. It's this back and forth.”
In 2013, a Loyola University Medical Center psychiatrist proposed a new subspecialty to diagnose and treat patients who suffer both depression and heart disease.
Dr. Angelos Halaris told Medscape Medical News that his idea of creating a “psychocardiology" specialty was a "pipe dream."
"But I wanted to put it out there because our colleagues in cardiology as well as in psychiatry need to realize there is a very clear association between emotional/psychiatric/psychological conditions and cardiovascular health," he said at the time.