SAN DIEGO– Elevated symptoms of anxiety are markedly more common than depression in adults with congenital heart disease, Lisa Deng reported at the annual meeting of the American College of Cardiology.
This observation isn’t reflected in the ACC/American Heart Association guidelines on the management of adult congenital heart disease (ACHD), which recommend that “a careful assessment of depressive symptoms and their possible overlap with symptoms of medical illness or side effects of medications must be part of the clinical evaluation of ACHD patients” (J. Am. Coll. Cardiol. 2008;52:e143-263).
Anxiety and depression have been shown to be associated with worse clinical outcomes in patients with heart disease. Given the high prevalence, deleterious impact, and treatable nature of anxiety symptoms, it makes sense to incorporate evaluation for both anxiety and depression in the clinical assessment of ACHD patients, according to Ms. Deng of Children’s Hospital of Philadelphia.
She reported on 134 patients (mean age, 35 years) attending an outpatient ACHD clinic, where they were assessed using the validated Hospital Anxiety and Depression Scale (HADS), the Satisfaction with Life Scale (SLS), and the Linear Analog Scale for Quality of Life (LAS). Of those patients, 45% had a history of arrhythmia and 20% had heart failure; 42% of subjects demonstrated elevated levels of anxiety as reflected in a HADS-Anxiety score of 8 or more out of a possible 21. In contrast, 12% had an elevated HADS-Depression score of 8 or more. Thus, anxiety was 3.5-fold more common than depression.
Of note, 15 of the 16 patients with depression had comorbid elevated levels of anxiety, but even though 42% of the ACHD patients had elevated anxiety scores, only 1 in 8 study participants had a note in their chart mentioning anxiety.
Patients with elevated anxiety reported significantly lower ratings than those with a HADS-Anxiety score of less than 8 on one quality-of-life measure – the SLS – but not on the LAS. In contrast, patients with depression scored significantly lower on both quality-of-life measures.
The clinical correlates of anxiety and depression differed in these ACHD patients. Half of the patients with elevated anxiety scores had a history of two or more surgical or interventional procedures, compared with 25% of subjects with a normal-range HADS-Anxiety score. One-fourth of patients with high depression scores were unemployed, a prevalence threefold greater than in nondepressive individuals. Also, 19% of patients with a HADS-Depression score of 8 or more had a history of arrhythmia, compared with 7% of nondepressive patients.
This study was supported by a research grant from Big Hearts in Little Bodies. Ms. Deng reported having no financial conflicts.