Lebherz Corinna, Frick Michael, Panse Jens, Wienstroer Philipp, Brehmer Katrin, Kerst Gunter, Marx Nikolaus, Mathiak Klaus, Hövels-Gürich Hedwig
Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
Front Pediatr. 2022 Jun 21;10:906385. doi: 10.3389/fped.2022.906385. eCollection 2022.
Anxiety and depression can worsen outcome in patients with heart disease. We elucidate the prevalence of anxiety and depression in a cohort of adults with congenital heart disease (ACHD).
Prospective screening for anxiety or depression was performed in 204 consecutive patients of the outpatient clinic of our tertiary care center using the Hospital Anxiety and Depression Scale (HADS) questionnaire and the distress thermometer (DT) as a potential ultra-short screening test. Functional data were assessed at liberty of the responsible physician. HADS scores ≥ 8 were considered doubtful and scores ≥ 11 as confirmed cases of anxiety or depression, respectively. HADS results were compared with a historical group of 100 patients with non-Hodgkin Lymphoma (NHL) as well as German reference values from the literature.
Patients from the ACHD cohort were 28 ± 10 years old (mean ± , 54% male), 34% had a simple, 51% a moderate, including 52 patients with transposition of the great arteries after arterial switch operation, and 15% a heart defect of severe complexity. Prevalence of depression in ACHD was comparable to the German normal population (5.9% ACHD vs. 5.4% control). In contrast, prevalence of anxiety was higher than expected from reference values (12.7% ACHD vs. 5.6% control). There was a positive association between psychological distress and NYHA class [anxiety: OR 2.67 (95% CI, 1.50-4.76) = 0.001; depression: OR 2.93 (95% CI, 1.60-5.35) = 0.0005], but not with age, gender, or heart defect severity. Percentages of patients with ACHD with anxiety were significantly higher than in a cohort of patients with indolent non-Hodgkin lymphoma (NHL) but comparable to those with aggressive NHL (HADS-A ≥ 11: ACHD 12.7%, indolent NHL 2.2%, aggressive NHL 13.2%; = 0.037 ACHD vs. indolent NHL; = 0.929 ACHD vs. aggressive NHL). The distress thermometer screening test had only a fair discriminatory ability (AUC 0.708; = 0.002) and is therefore of limited usability.
Adults with congenital heart disease exhibit an increased risk for anxiety disorders independently of the severity of the underlying heart defect. Anxiety prevalence was comparable to a historical cohort of patients with aggressive NHL underlining the importance of a routine screening for psychosocial distress in adults with congenital heart disease.
焦虑和抑郁会使心脏病患者的病情恶化。我们阐明了先天性心脏病成年患者队列（ACHD）中焦虑和抑郁的患病率。
在我们三级医疗中心门诊连续就诊的204例患者中，使用医院焦虑抑郁量表（HADS）问卷和痛苦温度计（DT）作为潜在的超短筛查测试，对焦虑或抑郁进行前瞻性筛查。功能数据由负责医生酌情评估。HADS评分≥8被视为可疑，评分≥11分别被视为确诊的焦虑或抑郁病例。将HADS结果与100例非霍奇金淋巴瘤（NHL）患者的历史队列以及文献中的德国参考值进行比较。
ACHD队列中的患者年龄为28±10岁（平均±，54%为男性），34%患有简单型心脏病，51%患有中型心脏病，其中包括52例动脉调转术后大动脉转位患者，15%患有严重复杂性心脏缺陷。ACHD中抑郁症的患病率与德国正常人群相当（ACHD为5.9%，对照组为5.4%）。相比之下，焦虑症的患病率高于参考值预期（ACHD为12.7%，对照组为5.6%）。心理困扰与纽约心脏协会（NYHA）心功能分级之间存在正相关[焦虑：比值比（OR）2.67（95%置信区间，1.50 - 4.76），P = 0.001；抑郁：OR 2.93（95%置信区间，1.60 - 5.35），P = 0.0005]，但与年龄、性别或心脏缺陷严重程度无关。ACHD中焦虑症患者的百分比显著高于惰性非霍奇金淋巴瘤（NHL）患者队列，但与侵袭性NHL患者相当（HADS - A≥11：ACHD为12.7%，惰性NHL为2.2%，侵袭性NHL为13.2%；ACHD与惰性NHL比较，P = 0.037；ACHD与侵袭性NHL比较，P = 0.929）。痛苦温度计筛查测试的鉴别能力一般（曲线下面积[AUC]为0.708；P = 0.002），因此实用性有限。
先天性心脏病成年患者患焦虑症的风险增加，与潜在心脏缺陷的严重程度无关。焦虑症患病率与侵袭性NHL患者的历史队列相当，这凸显了对先天性心脏病成年患者进行心理社会困扰常规筛查的重要性。
