Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.
Avalon University School of Medicine, Willemstad, Curaçao, Netherlands Antilles.
Am J Cardiol. 2020 Apr 15;125(8):1256-1262. doi: 10.1016/j.amjcard.2020.01.024. Epub 2020 Jan 30.
Despite the growing prevalence of adult congenital heart disease (ACHD), data on trends in prevalence of mental health disorders (MHD) among patients with ACHD remain limited. The National Inpatient Sample (2007 to 2014) was queried to identify the frequency and trends of MHD among ACHD hospitalizations (stratification by age, sex, and race); demographics and co-morbidities for ACHD cohorts, with (MHD+) versus without MHD (MHD-); the rate and trends of all-cause in-hospital mortality, disposition, mean length of stay, and hospitalization charges among both cohorts. A total of 11,709 (13.8%, mean age: 49.1 years, 56.0% females, 78.7% white) out of 85,029 ACHD patient encounters had a coexistent MHD (anxiety, depression, mood disorder, or psychosis). ACHD-MHD+ cohort was more often admitted nonelectively (38.1% vs 32.8%, p <0.001) and had a higher frequency of cardiac/extra-cardiac co-morbidities. The trends in prevalence of coexistent MHD increased from 10.3% to 17.5% (70% relative increase) from 2007 to 2014 with a consistently higher prevalence among females (from 13% to 20.3%) compared to males (from 7.6% to 15.5%) (p <0.001). The hospitalization trends with MHD increased in whites (12.1% to 19.8%) and Hispanics (5.9% to 12.7%). All-cause mortality was lower (0.7% vs 1.1%, p = 0.002) in ACHD-MHD+; however, mean length of stay (∼5.7 vs 4.9 days, p <0.001) was higher without significant difference in charges ($97,710 vs $96,058, p = 0.137). ACHD-MHD+ cohort was less often discharged routinely (declining trend) and more frequently transferred to other facilities and required home healthcare (rising trends). In conclusion, this study reveals increasing trends of MHD, healthcare resource utilization and a higher frequency of co-morbidities in patients with ACHD.
尽管成人先天性心脏病（ACHD）的患病率不断上升，但有关 ACHD 患者精神健康障碍（MHD）患病率趋势的数据仍然有限。使用 2007 年至 2014 年的全国住院患者样本（National Inpatient Sample），对 ACHD 住院患者（按年龄、性别和种族分层）中 MHD 的频率和趋势进行了分析；对 ACHD 队列的人口统计学和合并症进行了分析，其中 MHD+（存在 MHD）与 MHD-（不存在 MHD）；两个队列的全因院内死亡率、处置方式、平均住院时间和住院费用的比率和趋势。在 85029 例 ACHD 患者中，共有 11709 例（占 13.8%，平均年龄为 49.1 岁，女性占 56.0%，白人占 78.7%）存在合并的 MHD（焦虑、抑郁、心境障碍或精神病）。ACHD-MHD+组更多地被非选择性收治（38.1%比 32.8%，p<0.001），且更常伴有心脏/心脏外合并症。从 2007 年到 2014 年，合并 MHD 的患病率从 10.3%上升到 17.5%（增加了 70%），女性（从 13%上升到 20.3%）的患病率一直高于男性（从 7.6%上升到 15.5%）（p<0.001）。白人（从 12.1%上升到 19.8%）和西班牙裔（从 5.9%上升到 12.7%）的 MHD 住院趋势也有所增加。ACHD-MHD+患者的全因死亡率较低（0.7%比 1.1%，p=0.002）；然而，平均住院时间较长（约 5.7 天比 4.9 天，p<0.001），费用无显著差异（$97710 比 $96058，p=0.137）。ACHD-MHD+患者常规出院的比例较低（呈下降趋势），更多地转至其他医疗机构，并需要家庭医疗保健（呈上升趋势）。总之，这项研究揭示了 ACHD 患者 MHD、医疗资源利用和合并症发生率的上升趋势。
