Congenital Heart Disease 101 for C-L Psychiatry

Congenital heart disease (CHD) encompasses a diverse range of cardiac birth defects and is highly associated with a wide array of psychiatric and neurodevelopmental conditions such as autism spectrum disorder, attention-deficit/hyperactivity disorder, anxiety, depression, PTSD, and psychosis. For example, the lifetime prevalence of depression and anxiety is as high as 50% in this population. Despite the presence of potential stressors across the lifespan, most patients with CHD lack access to mental health care, which results in higher rates of psychological distress from a young age.

The 2022 American Heart Association Scientific Statement on psychological outcomes and interventions in patients with CHD calls for a “catalyst…to move initiatives forward in the clinical setting” and to “move from awareness to implementation” of mental health care. Consultation-liaison (C-L) psychiatrists are well-positioned to become this “catalyst” given the expertise in providing psychiatric treatment to those with complex medical conditions.

With medical advancements, more than 90% of newborns with CHD are surviving into adulthood. In fact, there are now more adults than children living with CHD in the United States. The aims of this symposium are to 1) Raise awareness about the unique physical and psychosocial challenges faced by patients with CHD, and 2) Equip C-L Psychiatrists, both pediatric and adult, with knowledge to provide nuanced psychiatric evaluation and treatment for patients with CHD across various medical settings.

In the first panel presentation, Dr. Pradeepkumar Charla, a cardiologist specializing in adult CHD, will discuss the prevalence of CHD and how the landscape is shifting with an increasing number of adults living with CHD. He will provide an overview of the varied spectrum of congenital heart defects, the most commonly encountered long-term complications, nationwide trends, and the unique challenges involved in providing optimal care.

This will be followed by Dr. Patricia Ibeziako, a pediatric C-L psychiatrist, who will provide an overview of common neuropsychological outcomes observed in patients with CHD from infancy to young adulthood. She will also share key findings from a longitudinal cohort study examining neuropsychological trajectories of children with transposition of the great arteries.

Dr. Adrienne Kovacs, a clinical and health psychologist, will focus on the unique psychosocial aspects of two key time points in the lives of individuals with complex CHD: the transition from pediatric to adult CHD care, and the transition to planning end-of-life care.

Lastly, Dr. Joy Choi, an adult C-L psychiatrist, will conclude the session with an overview of important psychological and neurocognitive considerations in the evaluation of patients with CHD for advanced cardiac therapies including transplantation. In particular, using a clinical vignette, she will highlight the importance of a nuanced assessment of treatment adherence.

References:

Kovacs AH, Brouillette J, Ibeziako P, et al. Psychological Outcomes and Interventions for Individuals With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes. 2022;15(8):e000110

Gilboa SM, Devine OJ, Kucik JE, et al. Congenital Heart Defects in the United States: Estimating the Magnitude of the Affected Population in 2010. Circulation. 2016;134(2):101-109.