Study Author Q&A: Congenital Heart Disease and Mental Health

Mental health disorders increasingly occur in conjunction with adult congenital heart disease (ACHD), with 13.8% of patients with ACHD reporting coexistent mental illness, according to study results published in The American Journal of Cardiology.

The study, conducted by Rupak Desai, MBBS, of the Atlanta Veterans Affairs Medical Center, Decatur, Georgia, and colleagues relied on data from the National Inpatient Sample between 2007 and 2014. Investigators examined 85,029 patient encounters, specifically focusing on hospitalizations, demographic information, and healthcare resource utilization.

During the 8-year study period, compared with patients with ACHD alone, patients with ACHD and mental health disorders experienced a higher frequency of serious comorbidities (P <.001) including hypertension, chronic pulmonary disease, obesity, neurologic disorders, diabetes, rheumatoid arthritis, and liver disease.

All-cause in-hospital mortality was lower in the group with comorbid mental disorders than in the group with ACHD alone (0.7% vs 1.1%, respectively; P =.002); total hospital charges were similar in both cohorts (P =.137). However, the study results indicated that patients with comorbid mental illness had a longer mean length of stay (5.7 vs 4.9 days; P <.001) and were more often admitted non-electively (32.8% vs 38.1%; P <.001). The investigators found that patients with ACHD and psychiatric conditions experienced a 70% relative increase in hospitalizations between 2007 and 2014 (P <.001).

Dr Desai and colleagues noted that the rise in the prevalence of mental health disorders in patients with CHD may be related to “stress from illness at an early age, increased medical interventions, the burden of hospital admissions during childhood, and difficulty coping with the physical limitations [of ACHD].”

To learn more about the challenges faced by this patient population, Psychiatry Advisor spoke with Dr Desai. The interview was edited for clarity, grammar, and readability.

Psychiatry Advisor: In your study, patients with ACHD and mental illness had lower all-cause mortality compared with patients with ACHD alone. What do you make of this finding?

Rupak Desai, MBBS: This finding shows that comorbid mental health disorders may not affect short-term in-hospital outcomes such as all-cause mortality, so we may need future studies with data on long-term follow-up and severity of mental health disorders to further comment on this association.

Psychiatry Advisor: Many medical conditions are linked to comorbid psychiatric disorders. What are the specific challenges concerning ACHD?

Dr Desai: The challenges concerning mental health in ACHD patients revolve around its chronicity and complexity. Furthermore, the variability of demographic characteristics and social stressors resulting from the disease requires a patient-centered approach to effectively screen comorbid conditions and strategize preventive management plans to improve the quality of life in patients with ACHD.

Psychiatry Advisor: Results of the study showed that total hospital charges were comparable across cohorts in the study despite the additional burden of mental illness in 1 group. Could you explain this finding?

Dr Desai: This could be either due to patients with ACHD and mental health disorders undergoing fewer interventions compared to ACHD patients without mental health disorders or lower severity of mental health disorders in ACHD not warranting high-cost psychiatric interventions and extended lengths of stay. Another possible reason for equivalent hospital charges could be frequent transfers of adults with CHD and mental health disorders to other facilities, including short-term hospitals, skilled nursing facilities, and intermediate care facilities.

Psychiatry Advisor: Have diagnosing practices influenced the greater prevalence of mental health disorders seen with ACHD? How do you explain this increase during the course of your study?

Dr Desai: The combination of raised awareness of mental health disorders in ACHD, improved screening practices in modern healthcare and improved survival and lifespan of ACHD patients amidst enhanced lifesaving interventions could have contributed to the greater prevalence of mental health disorders in this population subtype from 2007 to 2014.

Psychiatry Advisor: What can physicians, specifically psychiatrists, do to improve outcomes in this population?

Dr Desai: Psychiatrists should stay current with mental health statistics and research in this population to provide up-to-date education to their patients. Furthermore, a patient-centered approach which emphasizes a thorough understanding of the bidirectional relationship between the physical and mental health aspects of a patient’s health is crucial to improve the quality of life for ACHD patients.

Psychiatry Advisor: Finally, what are the implications of your findings and some potential future directions for the field?

Dr Desai: This study is important for understanding the multifaceted nature of mental health in ACHD, how the complexity is changing over time, and planning for future healthcare needs of this complex population. Future work should focus on improved screening for comorbid mental illness, apposite referrals to mental health professionals, and evaluation of therapeutics to improve long-term outcomes and quality of life of ACHD patients with mental health disorders.

Reference

Desai R, Patel K, Dave H, et al. Nationwide frequency. Sequential trends, and impact of comorbid mental health disorders on hospitalization, outcomes, and healthcare resource utilization in adult congenital heart disease [published online January 29, 2020]. Am J Cardiol. doi:10.1016/j.amjcard.2020.01.024