For people with heart defects, mental health support is essential to care at every age

Although many people born with congenital heart defects develop resilience and have a high quality of life, they may face a variety of health-related psychological and social challenges throughout their lives. More mental health support that is integrated into their routine health care is recommended to help them achieve optimal health and quality of life, according to a new scientific statement from the American Heart Association published today in Circulation: cardiovascular quality and outcomes.

Congenital heart (CHD) occur when people are born with structural abnormalities of the heart or blood vessels that affect the heart. Surgeries and catheter interventions are often required to address these issues. Most people with CHD survive into adulthood, and adults now outnumber children among the more than 2.4 million living with CHD in the United States. However, surgical intervention does not cure CHD. People may need multiple operations and require specialized heart care throughout their lives, especially if they were born with complex heart problems.

“Decades of research describe the psychological and social stressors and challenges that can occur throughout the lives of people with CHD,” said Adrienne H. Kovacs, Ph.D., chair of the scientific statement writing committee. and a clinical psychologist who specializes in working with people who have CHD. “It is long overdue to move from awareness to action and provide more resources and expertise mental health care for people living with CHD.

A scientific statement from the American Heart Association is an expert analysis of current research and may inform future guidelines. of the Association scientific statement 2011 on a related topic addressed developmental delays and other neurodevelopmental outcomes in children with coronary heart disease. However, this is the first statement to summarize the psychological and social challenges from childhood to adulthood and to review age-appropriate mental education Health interventions to improve quality of life.

According to the new statement, children with more complex CHD have a 5 times higher rate of receiving an anxiety diagnosis in their lifetime compared to children without CHD. Despite evidence of emotional, social, and behavioral difficulties, only a small fraction of children with CHD receive or participate in mental health evaluation or treatment. For adults with CHD, the rate of experiencing a mood or anxiety disorder in their lifetime is about 50%, compared to about 30% for adults in the general population.

The statement summarizes the psychosocial impact of CHD during various stages of life:

• Childhood-Babies may be exposed to frightening or painful procedures, and may be separated from caregivers and family members for long periods of time for surgery or other hospitalization. In response, babies with CHD may be hypersensitive to light and sound, have difficulty eating and sleeping, or show intense fear and distress, and may have developmental delays.
• Childhood—There may be additional hospitalizations and surgeries, therefore fewer opportunities to play or attend school, and they may also have developmental delays. In response, children with CHD may become socially withdrawn, experience symptoms of anxiety or depression, have difficulty in school, or display aggression or hyperactivity.
• Adolescence—Health issues can arise as teens strive to be independent, expand their social networks, and take on greater responsibility for managing their health care as they move from pediatric to adult care. In response, teens with CHD may struggle socially, become angry, challenged, or frustrated, or have body image issues. They may also display risk behaviors or fail to follow health recommendations.
• Adulthood—There may be new or worsening heart symptoms, repeat surgeries or other heart interventions during adulthood, and CHD can negatively impact financial, employment, insurance and family planning options. In response, adults with CHD may have difficulty with interpersonal relationships, higher education, or employment. They may also have trouble taking care of their health needs and worry about death and dying.

“It’s completely understandable to have a psychological reaction to living with a congenital heart defect. The condition presents numerous challenges throughout life and can include unexpected news, such as a person realizing they can no longer physically handle the demands of their job or learning that there are significant risks to pregnancy,” Kovacs said. “Many people with CHD are highly resilient in the face of these challenges. At the same time, we want to normalize psychological reactions and increase the prevalence of psychological wellness care to help people with CHD experience a full and healthy life.” “.

According to the statement, approaches to mental health care can encompass self-care strategies, such as relaxation techniques and hospital or online support groups; psychotherapy such as talk therapy for individuals, couples, families, or groups; and drug therapy where a medical team can determine the appropriate and safe heart medications for depression or anxiety.

The statement strongly advocates for the integration of mental health professionals within CHD specialty care teams. Comprehensive mental health care is normalized emotional reactions to health challenges, reduces stigma, improves timely access as health challenges arise, and provides coordinated care across the multidisciplinary health care team.

“The goal of this statement is to encourage psychologically informed care that empowers people with CHD and their families and provides emotional support,” Kovacs said. “We would like mental health assessment and support to be part of comprehensive care for all people with CHD rather than a special service offered only in a few special places or circumstances.”

Additionally, the statement highlights priority areas of research to better understand and improve psychological outcomes for people with CHD, including:

• how to better identify significant psychological distress;
• factors that can contribute to psychological resilience and well-being;
• obtain more information on the safety and efficacy of psychotropic medications at different ages; Y
• personalized approaches to mental health interventions.

This statement follows two other Association scientific statements addressing the care of people with CHD: a March 2022 scientific statement on support for transition from pediatric to adult care; and an April 2022 scientific statement addressing the impact of social determinants of health in CHD care throughout life.

This scientific statement was prepared by the volunteer writing group on behalf of the Council on Congenital Heart Disease and Heart Health in the Young (Young Hearts) and the Stroke Council of the American Heart Association. The writing group included a diverse and interdisciplinary group of experts with a long-standing commitment to the psychological care of people with CHD, including two authors with CHD.

American Heart Association scientific statements promote increased awareness of cardiovascular disease and stroke and help provide information health care decisions Scientific statements describe what is currently known about a topic and what areas need additional research. While scientific statements inform guideline development, they do not make treatment recommendations. The American Heart Association guidelines provide the Association’s official clinical practice recommendations.