Abstract

Objective: 

Improved long-term survival changed the treatment goals for adults with congenital heart disease (ACHD) by addressing the maintenance of quality of life (QoL) and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Moreover, it is associated with psychiatric comorbidities and metabolic disorders. In ACHD, the impact of timely changes of depression on these parameters is unknown. 

Methods: This prospective cross-sectional observational study included 150 patients (mean age 35.2 ± 11.3 years, 57% male) at baseline.  Follow-up evaluation incorporated 118 participants (mean follow-up at 4.8±0.6 years). Clinical expert interview diagnosed depression (DSM-IV). All participants comorbid with depressive disorder at baseline (30.7%) received specific treatment. Patients without (A) or with depression (B) in both surveys were compared with those characterized by remission of depressive symptoms (C). The four patients newly diagnosed as depressed were withdrawn from analysis. In addition, five patients died during the follow-up period. At follow-up, all patients received a regular check-up with clinical anamnesis, echocardiography, electrocardiography and cardiopulmonary exercise testing. The quality of life was assessed by the WHOQOL-BREF questionnaire and the Rand 36-Item Short Form Health Survey (SF-36) at both visits.

Results: At baseline and at follow-up patients without depression (A) (n=81) showed a high overall QoL. Over time exercise capacity declined significantly. A high proportion of patients (45%) were burdened by chronic depression. Those (B) (n=18) presented with a persisting low WHO overall QoL (<55%) and poor general health (<45%), anxiety symptoms increased (p=0.036). Exercise capacity decreased significantly (ΔPeakVO₂ ANOVA A -2.8 ml/min/kg B -4.5ml/min/kg C +0.1ml/min/kg B/C p=0.034*). Remission of depression (C) (n=15) exhibited significantly improved overall QoL (58.3% vs. 70.1%, p=0.033) and self-reported general health (53.2% vs. 69.4%, p=0.001). Exercise capacity remained stable. New-onset prediabetes was significantly lower compared to chronic depression (p=0.025).