Congenital Heart Disease Patients at Greater PTSD Risk

Adults living with congenital heart disease (CHD) may be at much more substantial risk for post-traumatic stress disorder (PTSD) than individuals in the general population, according to new research from the Children’s Hospital of Philadelphia.

In a single-center study, a team of CHOP researchers found as many as 1 in 5 adult patients experiencing PTSD symptoms, with roughly 1 in 10 demonstrating symptoms directly related to heart problems. Overall, the investigators enrolled patients with congenital heart defects, using 2 validated mental-health scales with questions related to anxiety, depression, and PTSD. Among the 134 participants completing 1 scale, 27, or 21%, met the standard for global PTSD symptoms. Of the 127 patients completing the other scale, 14 patients (11%) showed PTSD symptoms expressly linked to their CHD or treatment, according to the authors.
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The incidence of PTSD in this patient cohort, ranging from 11% to 21%, is much greater than the 3.5% rate found in the general population, the researchers note, adding that the prevalence of PTSD in adults with CHD is comparable to that seen in children with CHD as well as adults with acquired heart disease.

The investigators determined that 2 factors—elevated depressive symptoms and patients’ most recent cardiac surgery—were most strongly connected to PTSD in participating patients. The authors also found PTSD risk went up among patients whose cardiac procedures pre-dates recent medical and surgical advances, and noted that non-medical traumatic events may contribute to some patients’ PTSD as well.

Lead author Yuli Kim, MD, director of the Adult Congenital Heart Disease Center and assistant professor of medicine at the University of Pennsylvania and CHOP, notes that primary care practitioners caring for adult CHD patients “should be keyed into anxiety and anxiety disorders such as PTSD.

“We know of a strong association between mood disorders such as depression and heart disease,” says Kim, “but this study suggests there is a high prevalence of PTSD in this population, and they may be underdiagnosed and undertreated.”

“Many adults with congenital heart disease get lost to cardiology care, and it’s important for healthcare providers to ensure their patients have follow-up with adult congenital cardiology providers,” adds Sara Partington, MD, an attending physician at the Philadelphia Adult Congenital Heart Center and the division of cardiology at CHOP, and a co-author of the study.

Patients with congenital heart disease require lifelong medical follow-up, says Partington, who is also an assistant professor of clinical medicine at Penn Medicine. “But, as this study underscores, these patients also have important psychosocial complications that need to be addressed.”

Despite the “very high prevalence” of PTSD found in CHD patients in this study, “very few patients carried an official diagnosis of PTSD, or were receiving mental health treatment,” adds Partington.

“Healthcare providers can improve quality of life for their patients with congenital heart disease by inquiring about the psychosocial health of their patients,” she concludes, “and [by] ensuring that they have access to appropriate psychological and psychiatric support services.”

—Mark McGraw

Reference

Deng L, Khan A, et al. Prevalence and Correlates of Post-traumatic Stress Disorder in Adults With Congenital Heart Disease. American Journal of Cardiology. 2016.