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Freiberger A, Richter C, Huber M, Beckmann J, Freilinger S, Kaemmerer H, Ewert P, Kohls N, Henningsen P, Allwang C, Andonian-Dierks C. Post-Traumatic Distress in Adults With Congenital Heart Disease: an Under-Recognized Complication? Am J Cardiol 2023; 203:9-16. [PMID: 37478638 DOI: 10.1016/j.amjcard.2023.06.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
The stressful and potentially traumatic perception of repeated hospitalization, outpatient check-ups, and medical interventions places a high stress burden on patients with congenital heart disease (CHD). These experiences can lead to post-traumatic stress symptoms (PTSSs). This study aimed to estimate the prevalence of PTSSs in adults with CHD (ACHDs) and to identify the associated risk factors. In this cross-sectional study, 234 ACHDs were recruited from November 2021 to August 2022 at a dedicated tertiary care center. Data were collected on general health, anxiety and depression, PTSSs, and on quality of life using validated and standardized questionnaires. In addition, the reasons for PTSSs were assessed using free-text responses. Overall, 17.1% to 20.5% (mean age: 35.2 ± 10.8 [18 to 66] years, 46.6% women) of the enrolled patients met the criteria for clinically relevant PTSSs related to their CHD or treatment. The associated risk factors (p <0.05) included preexisting mental distress (odds ratio [OR] 4.86), depression (OR 5.565) and anxiety (OR 3.36,), level of perceived mental distress during the traumatic event (OR 1.46), and number of medical procedures (OR 1.17). In addition, a worse clinical state was associated with more PTSSs (p = 0.018). Using free-text responses, the various reasons for PTSSs were identified, ranging from cardiac procedures to social stigma. In conclusion, the high prevalence of PTSSs calls for increased awareness of PTSSs in ACHDs in cardiovascular care. PTSSs and their associated disorder can adversely affect the manifestation and progression of cardiac disease. Thus, it is necessary to reflect upon psychocardiac prevention and intervention as an integral part of multidisciplinary cardiac care.
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Affiliation(s)
- Annika Freiberger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany.
| | - Cristina Richter
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Maximilian Huber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Niko Kohls
- Division of Health Promotion, Department of Social Work and Health, University of Applied Sciences Coburg, Coburg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Caroline Andonian-Dierks
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
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Cook SC, Saidi A, Singh HS, Madder RD, Cohen SB, Van Oosterhout S, Samuel BP, Finn MT. Preprocedural Anxiety in Adults With Congenital Heart Disease: The PANIC Study. JACC. ADVANCES 2023; 2:100589. [PMID: 38939501 PMCID: PMC11198359 DOI: 10.1016/j.jacadv.2023.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2024]
Abstract
Background Preprocedural anxiety may have detrimental effects both cognitively and physiologically. Objectives The objective of this study was to determine the association between state (situational) and trait (persistent in everyday life) anxiety and differences between the adult congenital heart disease (ACHD) and acquired heart disease populations. Methods The State-Trait Anxiety Inventory and financial stress scale were administered to adults with acquired and CHD at 4 tertiary referral centers in the United States prior to cardiac catheterization. Student's t-test and least absolute shrinkage and selection operator regression analyses were used to assess differences in anxiety between groups and identify the optimal model of predictors of anxiety. Results Of the 291 patients enrolled, those with CHD (n = 91) were younger (age 41.3 ± 16.3 years vs 64.7 ± 11.3 years, P < 0.001), underwent more cardiac surgeries (P < 0.001), and had higher levels of trait anxiety (t[171] = 2.62, P = 0.001, d = 0.33). There was no difference in state anxiety between groups (t[158.65] = 1.37, P = 0.17, d = 0.18). State anxiety was singularly associated with trait anxiety. Trait anxiety was negatively associated with age and positively associated with state anxiety and financial stress. Patients with CHD of great complexity were more trait (F[2,88] = 4.21, P = 0.02) and state anxious (F[2,87] = 4.59, P = 0.01), though with relatively small effect size. Conclusions Trait anxiety levels are higher in the ACHD population and directly associated with state anxiety. Specialists caring for ACHD patients should not only recognize the frequency of trait anxiety but also high-risk subgroups that may benefit from psychological or social interventions to reduce preprocedural anxiety.
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Affiliation(s)
- Stephen C. Cook
- Indiana University Health Adult Congenital Heart Disease Program, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Arwa Saidi
- Congenital Heart Center, University of Florida Health, Gainesville, Florida, USA
| | - Harsimran S. Singh
- Adult Congenital Heart Disease Program, Weill Cornell Medical Center, New York, New York, USA
| | - Ryan D. Madder
- Division of Cardiology, Corewell Health, Grand Rapids, Michigan, USA
| | - Scott B. Cohen
- Adult Congenital Heart Disease Program, Herma Heart Institute, Milwaukee Hospital-Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Stacie Van Oosterhout
- Division of Cardiology, Corewell Health Office of Research and Education, Grand Rapids, Michigan, USA
| | - Bennet P. Samuel
- Karl and Patricia Betz Congenital Heart Center, Corewell Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan, USA
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Moons P, Van Bulck L, Daelman B, Luyckx K. Mental health in adult congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults. Nat Rev Cardiol 2023; 20:126-137. [PMID: 36045220 DOI: 10.1038/s41569-022-00749-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.
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