Top Things to Know: Psychological Outcomes and Interventions for Individuals with Congenital Heart Disease (CHD)
Published: July 14, 2022
Prepared by Paul St. Laurent, DNP, RN, Senior Science and Medicine Advisor, Lead
- The lifetime prevalence of depression and anxiety in those with congenital heart disease (CHD) is as high as 50% and has been associated with higher medical costs in addition to greater morbidity and mortality.
- This statement summarizes the psychological outcomes of patients with CHD across the lifespan and reviews age-appropriate mental health interventions including psychotherapy and pharmacotherapy.
- Risk factors for adverse psychological and neurodevelopmental outcomes in individuals with CHD such as altered fetal circulation and cerebral hemodynamics, hypoxia and perioperative neurologic injury are multiple, inter-related and cumulative, and may exert influence in utero and across the life course.
- Children with complex CHD and those with comorbid medical conditions are at greater risk of neurodevelopment impairment and emotional and behavioral dysregulation and show early signs of social withdrawal and elevated rates of internalizing (e.g., anxiety, depression; 25%) and externalizing (e.g., aggression, hyperactivity; 15%) difficulties.
- For adults with CHD disease, related stressors include awareness of the potential for future medical interventions and life-threatening complications, concerns about early mortality, potential restrictions regarding family planning, and financial challenges.
- Most children, young people and adults with CHD who report clinically significant psychological distress in research studies have not received timely mental health treatment (psychotherapy or psychotropic medication) or other appropriate intervention.
- Approaches to psychotherapy that might be offered to individuals with CHD include cognitive-behavioral therapy, trauma-focused therapy, eye-movement desensitization reprocessing (EMDR), mindfulness-based interventions and psychodynamically-oriented therapies.
- Treatment for comorbid psychiatric disorders may include psychotropic medications like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), benzodiazepine anxiolytics, alpha-2 adrenergic receptor agonists, psychostimulants and antipsychotics.
- Although psychological well-being is fundamental to living a healthy, productive life, the health care system often falls well short of identifying, addressing, and treating psychological distress among those living with CHD.
- The goal of this statement is to serve as a catalyst to spur efforts for large-scale research studies examining psychological experiences, outcomes, and interventions tailored to this population and for integrating mental health professionals within CHD interdisciplinary teams to implement a care model that offers patients the best possible quality of life.
Citation
Kovacs AH, Brouillette J, Ibeziako P, Jackson JL, Kasparian NA, Kim YY, Livecchi T, Sillman C, Kochilas LK; on behalf of the American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Stroke Council. Psychological outcomes and interventions for individuals with congenital heart disease: a scientific statement from the American Heart Association [published online ahead of print July 14, 2022]. Circ Cardiovasc Qual Outcomes. doi: 10.1161/HCQ.0000000000000110