TY - JOUR
T1 - Prevalence and prognostic association of a clinical diagnosis of depression in adult congenital heart disease
T2 - Results of the boston adult congenital heart disease biobank
AU - Carazo, Matthew R.
AU - Kolodziej, Meghan S.
AU - Dewitt, Elizabeth S.
AU - Kasparian, Nadine A.
AU - Newburger, Jane W.
AU - Duarte, Valeria E.
AU - Singh, Michael N.
AU - Opotowsky, Alexander R.
N1 - Funding Information:
This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. This work was also partially supported by an investigator-initiated study research grant from Roche Diagnostics (Indianapolis, IN). Drs Opotowsky, Duarte, and Singh are supported by the Dunlevie Family Fund. Dr Kasparian is the recipient of a National Heart Foundation of Australia Future Leader Fellowship (101229) and a 2018 to 2019 Harkness Fellowship in Healthcare Policy and Practice from the Commonwealth Fund.
Publisher Copyright:
© 2020, American Heart Association Inc.. All rights reserved.
PY - 2020/5/5
Y1 - 2020/5/5
N2 - BACKGROUND: In adults with acquired heart disease, depression is common and associated with adverse outcomes. Depression may also be important in adults with congenital heart disease (CHD). METHODS AND RESULTS: We conducted a cohort study of outpatients with CHD, aged ≥18 years, enrolled in a prospective biobank between 2012 and 2017. Clinical data were extracted from medical records. Survival analysis assessed the relationship between depression, defined by a history of clinical diagnosis of major depression, with all-cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization. A total of 1146 patients were enrolled (age, 38.5±13.8 years; 49.6% women). Depression had been diagnosed in 219 (prevalence=19.1%), and these patients were more likely to have severely complex CHD (41.3% versus 33.7%; P=0.028), cyanosis (12.1% versus 5.7%; P=0.003), and worse functional class (≥II; 33.3% versus 20.4%; P<0.0001), and to be taking antidepressant medication at time of enrollment (68.5% versus 5.7%; P<0.0001). Depression was associated with biomarkers indicative of inflammation (hsCRP [high-sensitivity C-reactive protein], 1.71 [25th–75th percentile, 0.82– 4.47] versus 1.10 [0.45–2.40]; P<0.0001) and heart failure (NT-proBNP [N-terminal pro-B-type natriuretic peptide], 190 [92–501] versus 111 [45–264]; P<0.0001). During follow-up of 605±547 days, 137 participants (12.0%) experienced the composite outcome, including 33 deaths (2.9%). Depression was associated with increased risk for both all-cause mortality (multivariable hazard ratio, 3.0; 95% CI, 1.4–6.4; P=0.005) and the composite outcome (multivariable hazard ratio, 1.6; 95% CI, 1.1–2.5; P=0.025), adjusting for age, sex, history of atrial arrhythmia, systolic ventricular function, CHD complexity, and corrected QT interval. CONCLUSIONS: In adults with CHD, major depression is associated with impaired functional status, heart failure, systemic inflammation, and increased risk for adverse outcomes.
AB - BACKGROUND: In adults with acquired heart disease, depression is common and associated with adverse outcomes. Depression may also be important in adults with congenital heart disease (CHD). METHODS AND RESULTS: We conducted a cohort study of outpatients with CHD, aged ≥18 years, enrolled in a prospective biobank between 2012 and 2017. Clinical data were extracted from medical records. Survival analysis assessed the relationship between depression, defined by a history of clinical diagnosis of major depression, with all-cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization. A total of 1146 patients were enrolled (age, 38.5±13.8 years; 49.6% women). Depression had been diagnosed in 219 (prevalence=19.1%), and these patients were more likely to have severely complex CHD (41.3% versus 33.7%; P=0.028), cyanosis (12.1% versus 5.7%; P=0.003), and worse functional class (≥II; 33.3% versus 20.4%; P<0.0001), and to be taking antidepressant medication at time of enrollment (68.5% versus 5.7%; P<0.0001). Depression was associated with biomarkers indicative of inflammation (hsCRP [high-sensitivity C-reactive protein], 1.71 [25th–75th percentile, 0.82– 4.47] versus 1.10 [0.45–2.40]; P<0.0001) and heart failure (NT-proBNP [N-terminal pro-B-type natriuretic peptide], 190 [92–501] versus 111 [45–264]; P<0.0001). During follow-up of 605±547 days, 137 participants (12.0%) experienced the composite outcome, including 33 deaths (2.9%). Depression was associated with increased risk for both all-cause mortality (multivariable hazard ratio, 3.0; 95% CI, 1.4–6.4; P=0.005) and the composite outcome (multivariable hazard ratio, 1.6; 95% CI, 1.1–2.5; P=0.025), adjusting for age, sex, history of atrial arrhythmia, systolic ventricular function, CHD complexity, and corrected QT interval. CONCLUSIONS: In adults with CHD, major depression is associated with impaired functional status, heart failure, systemic inflammation, and increased risk for adverse outcomes.
KW - Adult congenital heart disease
KW - Adverse effects
KW - Biomarkers
KW - Depression
KW - Prognosis
KW - Survival
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U2 - 10.1161/JAHA.119.014820
DO - 10.1161/JAHA.119.014820
M3 - Article
C2 - 32342722
AN - SCOPUS:85084272083
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e014820
ER -