Kelia N. Lopez
PHILADELPHIA — Children and adolescents with arrhythmia disorders are more likely to be diagnosed with depression, anxiety or ADHD than those without them, according to data presented at the American Heart Association Scientific Session.
Although previous studies showed that youths with congenital heart disease had elevated risk for conditions such as depression and anxiety, little were known about youths with cardiac arrhythmias, Kelia N. Lopez, MD, MPH, medical director of cardiology transition medicine and assistant professor of pediatrics in the division of pediatric cardiology at Texas Children’s Hospital-Baylor College of Medicine, told Healio.
“We were noting that a decent proportion of our adolescents that we see (both structural heart disease as well as arrhythmias only) were on ADHD medications, as well as exhibiting signs of anxiety and depression when they were screened by our team,” she said in an interview. “We wondered how many of our patients were diagnosed or treated for these conditions overall and at what age. Thus, the thought came to do a formal cross-sectional study using our own electronic medical record data to look at our arrhythmia patients (without congenital heart disease) and determine the prevalence of anxiety and/or depression and ADHD compared with two chronic disease populations that have existing literature documenting anxiety and depression — those with cystic fibrosis and those with sickle cell disease. We also compared the patients with arrhythmia to the general population cohort that had none of the aforementioned conditions.”
The cohort included 251,020 patients, of whom 7,371 had cardiac arrhythmias (68% < age 10 years; 52% boys).
Among those with cardiac arrhythmias, 21% had a diagnosis of or prescription for a medication for depression or anxiety vs. 24% of those with congenital heart disease, 23% of those with cystic fibrosis, 5% with sickle cell disease and 3% of controls with none of those conditions, according to the researchers.
Compared with controls, youths with cardiac arrhythmias had more than a ninefold increased odds of depression or anxiety (OR = 9.4; 95% CI, 8.81-9.94) and more than a fourfold increased odds of ADHD (OR = 4.76; 95% CI, 4.3-5.25), Lopez and colleagues found.
Compared with patients with sickle cell disease, youths with cardiac arrhythmias had elevated odds of depression or anxiety (OR = 5.3; 95% CI, 3.88-7.28) and ADHD (OR = 1.86; 95% CI, 1.29-2.69), whereas compared with patients with cystic fibrosis, youths with cardiac arrhythmias had elevated odds of depression or anxiety (OR = 1.61; 95% CI, 1.21-2.13).
“Screening for depression, anxiety and ADHD in youth with cardiac arrhythmias and other chronic conditions should be considered at early ages,” Lopez told Healio. “Lower rates of diagnosis for depression, anxiety and ADHD in minority patients warrants further investigation. Consideration for cardioselective beta-blockers, as opposed to nonselective beta-blockers, should be given to patients at risk for depression and anxiety.” – by Erik Swain
Lopez KN, et al. Presentation Sa4066. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosures: The authors report no relevant financial disclosures.