Adults with congenital heart disease (CHD) are more likely to have impaired functional status, biomarker profiles indicative of systemic inflammation and heart failure, and increased risk for death or cardiovascular events if they have major depression, according to an article published in Journal of the American Heart Association.

Matthew R. Carazo, MD, from the division of cardiology at Emory University School of Medicine, Atlanta, Georgia, and colleagues assessed the relationship between depression, defined by a history of clinical diagnosis, with all-cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization. The study included medical record data from 1146 adults aged ≥18 years enrolled in the Boston CHD biobank between 2012 and 2017. Patients’ average age at time of enrollment was 38.5±13.8 years, and 49.6% were women.

Depression had been diagnosed in 219 of the patients (19.1%), who were more likely to have severely complex CHD (classified per the 32nd Bethesda conference guidelines; 41.3% vs 33.7%; P =.028), cyanosis (defined as resting arterial oxygen saturation <92%; 12.1% vs 5.7%; P =.003), and worse functional class (New York Heart Association class ≥II; 33.3% vs 20.4%; P <.0001). They were also more likely to be taking an antidepressant medication at the time of enrollment (68.5% vs 5.7%; P <.0001).

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Depression was associated with biomarkers indicative of inflammation, particularly high-sensitivity C-reactive protein, (1.71 vs 1.10 mg/L; P <.0001) and heart failure, indicated by N-terminal pro-B-type natriuretic peptide, (190 vs 111 pg/mL; P <.0001). During follow-up (average, 605±547 days), 12.0% of patients experienced the composite outcome, including 33 deaths (2.9%). After adjusting for age, sex, history of atrial arrhythmia, systolic ventricular function, CHD complexity, and corrected QT interval, depression was associated with higher risk for both all cause mortality (multivariable hazard ratio [HR], 3.0; 95% CI, 1.4-6.4; P =.005) and the composite outcome (multivariable HR, 1.6; 95% CI, 1.1-2.5; P =.025). 

The investigators noted that clinical depression is common in adults with CHD, especially women and individuals with lower functional status. However, study limitations included the inclusion of patients with varying depression severity and timing of depression diagnosis, as patients with long term remission of depression could bias results.

The researchers noted, “Screening for depression may be appropriate to both facilitate appropriate treatment and identify a subgroup of patients at higher risk for adverse outcomes.”


Carazo MR, Kolodziej MS, DeWitt ES, et al. Prevalence and prognostic association of a clinical diagnosis of depression in adult congenital heart disease: results of the Boston adult congenital heart disease biobank. J Am Heart Assoc. 2020;9(9):e014820.