Youths With Cardiac Arrhythmia Likely to Have Depression, Anxiety, ADHD

PHILADELPHIA — Adolescents and children with cardiac arrhythmias are more likely to have anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) than their counterparts with other chronic childhood medical conditions or no chronic conditions, according to research presented at the 2019 American Heart Association Scientific Sessions, held November 16-18 in Philadelphia, Pennsylvania.^1,2 Investigators suggested screening young patients with heart arrhythmias for these conditions to ensure proper treatment.

Higher rates of anxiety, depression, and ADHD have been previously described in young adults with congenital heart disease (CHD), but similar data on youths with cardiac arrhythmias are limited. The current study was designed to characterize ADHD and depression/anxiety in youths with a cardiac arrhythmia compared with the general youth population and youths with other chronic diseases.

Using the electronic medical records of a large pediatric hospital for the period from 2011 to 2016, the researchers compared data for patients younger than age 18 years without CHD and with cardiac arrhythmias and patients with cystic fibrosis, CHD, sickle cell disease, or none of these diagnoses (control). The researchers chose sickle cell disease and cystic fibrosis because they are chronic conditions managed with medications and usually involve multiple hospitalizations. Predictor variables included insurance type, sex, age, race/ethnicity, and neighborhood poverty. The primary end point was an International Classification of Diseases, Ninth or 10th Revisions’ diagnosis and/or prescriptions for depression/anxiety or ADHD medication. Logistic regression analyses were used to predict having depression/anxiety, ADHD, or both conditions for patients with cardiac vs noncardiac arrhythmia.

Investigators identified 251,020 unique patients for analysis. The patients with cardiac arrhythmia (n=7371) were largely boys (52%), Hispanic (45%), and younger than age 10 years (68%); the majority of these had public insurance (57%). Overall, 21% of patients with cardiac arrhythmia had depression/anxiety compared with 24% of patients with CHD, 23% with cystic fibrosis, 5% with sickle cell disease, and 3% of control participants.

Compared with the control group, patients with cardiac arrhythmia had approximately 9 times higher odds for depression/anxiety (odds ratio [OR], 9.4; 95% CI, 8.81-9.94), and 4.7 times higher odds for ADHD (OR 4.76; 95% CI, 4.3-5.25). Patients with cardiac arrhythmia had 1.6 times higher odds of medication for diagnosis of depression/anxiety (OR 1.61; 95% CI, 1.21-2.13) compared with patients with cystic fibrosis and approximately 5 times higher odds (OR 5.3; 95% CI, 3.88-7.28) compared with patients with sickle cell disease. Patients with a cardiac arrhythmia also had 1.8 times the odds for ADHD (OR 1.86; 95% CI, 1.29-2.69) compared with patients with sickle cell disease. No significant interactions were seen between a diagnosis of ADHD or depression/anxiety and neighborhood poverty.

Study investigators concluded that these findings indicate that “screening for [depression/anxiety] and ADHD should be considered in youth[s] with [cardiac arrhythmias] as well as other chronic childhood diseases.”

References

1. Lopez KN, Gonzalez VJ, Cutitta KE, Shabosky J, Bilal, Kimbro RT. Depression, anxiety, and attention deficit hyperactivity disorder in youth with cardiac arrhythmias: a cross sectional comparative study [AHA abstract 13753].  Circulation. 2019;140:A13753.

2. Youth with abnormal heart rhythms more likely to have ADHD, anxiety, depression [news release]. Dallas, TX: American Heart Association; November 11, 2019. Accessed November 13, 2019.