Children and teens with cardiac arrhythmias are more likely to have depression, anxiety and attention deficit hyperactivity disorder (ADHD) compared with those of similar ages without chronic medical conditions or with certain select chronic childhood diseases, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2019 (AHA 2019; 16–18 November, Philadelphia, USA).
Higher rates of depression, anxiety and ADHD have previously been described in young adults born with structural heart defects, according to the team which carried out the study, which was led by Keila N Lopez (Texas Children’s Hospital-Baylor College of Medicine, Houston, USA). The researchers used retrospective data from the electronic medical record of a large paediatric hospital between 2011–2016 to characterise depression/anxiety and ADHD in youth with cardiac arrhythmia compared to the general population and other chronic diseases.
Data were used to compare non-congenital heart disease cardiac arrhythmia patients, aged four–eight years, to congenital heart disease patients without arrhythmias, cystic fibrosis (CF), sickle cell disease (SC), and all other patients without these diagnoses. Predictor variables included age, sex, race/ethnicity, insurance type, and specific beta-blocker therapy. The primary outcome variable was an ICD-9 or 10 diagnosis and/or medication prescribed for depression/anxiety or ADHD. Logistic regression analyses were used to predict depression/anxiety, ADHD, or having both conditions, for cardiac arrhythmia and non-cardiac arrhythmia patients.
Researchers identified 123,000 unique patients and 3,961 cardiac arrhythmia patients. Cardiac arrhythmia patients were largely <10 years old (44%), Hispanic (42%), and had public insurance (53%); 50% of the arrhythmia patients were male. They found that overall, 27% of arrhythmia youths had a diagnosis or medication for depression/anxiety compared to 18% of complex congenital heart disease youths, 23% of CF patients, 8% of SC disease patients, and 5% of the control population.
Lopez and colleagues found that, compared to the control population, patients with regular (non-lethal) and severe (lethal) cardiac arrhythmias had roughly six times higher odds of depression/anxiety (OR 6.3, 95% confidence interval [CI] 5.8–6.8, and OR 6.1, 95% CI 5.8–6.8, respectively), and roughly three times higher odds of ADHD (regular: OR 3, 95% CI 2,6–3.5; severe: OR 3.1, 95% CI 1.5–6.2). Compared to CF, they found that those with regular and severe cardiac arrhythmia have 1.4 times higher (95% CI 1.02–1.9) and 1.9 times higher (95% CI 1.1–3.2) odds of medication for/diagnosis of depression/anxiety, respectively. Compared to SC patients, they found that those with regular and severe cardiac arrhythmia have a 3.3 times higher odds (95% CI 2.3-4.6) and 4.4 times higher odds (95% CI 2.6–7.6) of medication for/diagnosis of depression/anxiety, respectively. While there was no statistically significant difference in ADHD compared to the CF population, compared to SC, those with regular and severe cardiac arrhythmias have a 1.7 times higher odds (95% CI 1.1–2.8) and 2.3 times higher odds (95% CI 1–5.4) of ADHD.
Other important and pertinent findings were that youths with cardiac arrhythmia have higher odds of depression/anxiety medication or diagnosis compared to controls and patients with cystic fibrosis and sickle cell disease, and that youths with cardiac arrhythmias have higher odds of ADHD compared to control subjects and sickle cell disease populations. In addition, youths with cardiac arrhythmias on non-selective beta-blockers had higher rates of diagnosis/treatment for depression/anxiety compared to cardioselectives (beta blockers that target the heart). Finally, depression/anxiety and ADHD diagnoses were noted to be much lower in minority populations.
“This may be the first study of this size looking at children and teenagers with various cardiac arrhythmias (but without structural heart disease) that have been diagnosed with or are taking medication for anxiety and/or depression,” Lopez said.
And she emphasised to Cardiac Rhythm News: “It is important to take care of children’s arrhythmias as well as their mental health. Lower rates of diagnosis for depression/anxiety and ADHD in minority patients with arrhythmias warrants further investigation. Screening for anxiety and/or depression should be considered in children and adolescents’ cardiac arrhythmias and other chronic diseases.”