Depression requiring anti-depressant drug therapy in adult congenital heart disease: prevalence, risk factors, and prognostic value

Eur Heart J. 2016 Mar 1;37(9):771-82. doi: 10.1093/eurheartj/ehv386. Epub 2015 Aug 27.

Abstract

Background: Depression is prevalent in adults with congenital heart disease (ACHD), but limited data on the frequency of anti-depressant drug (ADD) therapy and its impact on outcome are available.

Methods and results: We identified all ACHD patients treated with ADDs between 2000 and 2011 at our centre. Of 6162 patients under follow-up, 204 (3.3%) patients were on ADD therapy. The majority of patients were treated with selective serotonin-reuptake inhibitors (67.4%), while only 17.0% of patients received tricyclic anti-depressants. Twice as many female patients used ADDs compared with males (4.4 vs. 2.2%, P < 0.0001). The percentage of patients on ADDs increased with disease complexity (P < 0.0001) and patient age (P < 0.0001). Over a median follow-up of 11.1 years, 507 (8.2%) patients died. After propensity score matching, ADD use was found to be significantly associated with worse outcome in male ACHD patients [hazard ratio 1.44 (95% confidence interval 1.17-1.84)]. There was no evidence that this excess mortality was directly related to ADD therapy, QT-prolongation, or malignant arrhythmias. However, males taking ADDs were also more likely to miss scheduled follow-up appointments compared with untreated counterparts, while no such difference in clinic attendance was seen in females.

Conclusions: The use of ADD therapy in ACHD relates to gender, age, and disease complexity. Although, twice as many female patients were on ADDs, it were their male counterparts, who were at increased mortality risk on therapy. Furthermore, males on ADDs had worse adherence to scheduled appointments suggesting the need for special medical attention and possibly psychosocial intervention for this group of patients.

Keywords: Adult congenital heart disease; Depression; Mortality; Outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Antidepressive Agents / therapeutic use*
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Cause of Death
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / mortality
  • Female
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / psychology*
  • Humans
  • Kaplan-Meier Estimate
  • Long QT Syndrome / mortality
  • Long QT Syndrome / psychology
  • Male
  • Prognosis
  • Risk Factors
  • Serotonin Uptake Inhibitors / therapeutic use
  • Sex Distribution

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors