Excess mortality and cardiovascular risk in adults with congenital heart disease and mental disorder

Introduction Due to advancements in medical and surgical treatments, more than 97% of children born in Sweden with a congenital heart disease (ACHD) are expected to reach adulthood. Previous studies have shown an increased risk of mental disorder among patients with ACHD compared to the general population without ACHD. However, few studies have investigated the risk of mortality and morbidity among ACHD patients with and without mental disorder. Purpose To investigate the long-term risk after a mental disorder in ACHD patients and to compare the risk of mortality and morbidity with ACHD patients without mental disorder. Methods All patients with a diagnosis of ACHD born in Sweden from 1952 to 2005 and who survived until age 18 years were identified from the Swedish National Patient Register. Each ACHD patient with a mental disorder was matched to two ACHD patients without mental disorder on birth year, sex and lesion complexity. All ACHD patients were followed for each outcome separately (death, cardiovascular disease, stroke, ischemic heart disease or malignancy) until first occurrence or end of study period (December 31, 2023), whichever occurred first. Cox proportional Hazard regression model was used to estimate hazard ratios for mortality and morbidity. The Kaplan-Meier method was used to estimate survival probabilities. Results In this nationwide observational study, 18 749 ACHD patients were included. A total of 6360 patients developed mental disorders and had a mean follow up of 10.4 ± 8.4 years. The proportion of mental disorder was higher in women (n=3542; 55.7%) than in men (n=2818; 44.3%). Survival probability for ACHD patients with mental disorders was 55% at 50 years of follow-up, compared to 74% in the group with no record of mental disorder in the National Patient Register (Figure 1). After adjusting for age at diagnosis of mental disorder, sex and comorbidities, ACHD patients with a mental disorder had an increased risk of all-cause mortality (adjusted hazard ratio (aHR) 3.13, 95% confidence interval (CI) 2.68-3.65), cardiovascular disease (aHR 1.64, 95% CI 1.43-1.87), stroke (aHR 1.73, 95% CI 1.47-2.03), ischemic heart disease (aHR 1.91, 95% CI 1.58-2.30) but not for malignancy (aHR 1.06 95% CI 0.90-1.24) compared to ACHD patients without mental disorder. Conclusion ACHD patients who develop mental disorder have worse survival and an increased risk of mortality and morbidity compared with ACHD patients without mental disorder. Screening for mental disorder should be considered in all patients with ACHD.