Children and teens with abnormal heart rhythms (cardiac arrhythmias) are more likely to suffer from depression, anxiety and attention deficit hyperactivity disorder (ADHD) when compared to those of similar ages without chronic medical conditions – or with certain select chronic childhood diseases.
This is according to preliminary research that was presented at the American Heart Association’s Scientific Sessions 2019 earlier this month. The event is an annual, premier global exchange looking at the latest advances in cardiovascular science for researchers and clinicians.
What is cardiac arrhythmia?
Cardiac arrhythmia, the medical term for an irregular heartbeat or abnormal heart rhythm, can occur at any age, explains the Arrhythmia Alliance (A-A), and occurs when the heart beats too slowly (bradycardia), or too quickly (tachycardia).
Depending on the cause, the condition can be treated through a permanent pacemaker implantation, or several other strategies.
Africa is experiencing an increasing burden of cardiac arrhythmias, indicates a 2019 study published in the Journal of the American College of Cardiology. The study draws attention to the need for appropriate care that remains largely unmet because of multiple factors such as inadequate funding and a shortage of essential medical expertise. However, it also mentions that it is only South Africa and several North African countries that provide complete services for cardiac arrhythmias.
The preliminary findings follow previous research suggesting the same higher rates for those conditions in young adults born with structural heart defects (congenital heart disease), but this study may be the first of its size to look at children and teenagers with various cardiac arrhythmias (but without structural heart disease), who have been diagnosed with, or are taking medication for anxiety and/or depression, said Keila N. Lopez, M.D., M.P.H., lead author of the study, medical director of Cardiology Transition Medicine and assistant professor of paediatrics in the Division of Pediatric Cardiology at Texas Children's Hospital-Baylor College of Medicine in Houston. Lopez is also a member of the American Heart Association's Congenital Cardiac Defect Committee.
The records of more than a quarter of a million children admitted to, or seen in the emergency room of Texas Children’s Hospital between 2011 and 2016 were analysed. Kids with arrhythmias were nine times more likely to be diagnosed or treated for anxiety and/or depression and almost five times more likely to be diagnosed or treated for ADHD, compared to kids without any certain chronic diseases.
Data on more than 7 300 children with abnormal heart rhythms were reviewed and compared to children with congenital heart disease, cystic fibrosis, sickle cell disease and children with none of these chronic conditions (controls).
"We chose cystic fibrosis and sickle cell disease because they are chronic diseases that are managed with medications and usually involve multiple hospitalisations," Lopez said.
The research found the following:
- More than 20% of kids with arrhythmias, congenital heart disease and cystic fibrosis had been diagnosed with, or were prescribed medication for depression and/or anxiety, compared with 5% of children with sickle cell disease and 3% of the control group.
- Kids with arrhythmias were nine times more likely to be diagnosed or treated for anxiety and/or depression, and almost five times more likely to be diagnosed or treated for ADHD, compared to kids without any of the identified chronic diseases in the study.
- Kids with arrhythmias were one and a half times as likely to be diagnosed or treated for anxiety and/or depression than those with cystic fibrosis, and more than five times as likely to be diagnosed or treated for anxiety and/or depression than those with sickle cell disease.
What does this mean?
Lopez stressed the importance of taking care of children’s arrhythmias as well as their mental health.
“Screening for anxiety and/or depression should be considered in children and adolescents with cardiac arrhythmias and other chronic diseases," she added.
More than this, the research importantly shows that, "There's an entire population of kids out there with abnormal heart rhythms who don't have congenital heart disease who may be suffering very specifically and significantly from depression and ADHD, that we need to potentially identify and treat to improve their quality of life,” said Bradley S. Marino, M.D., M.P.P., M.S.C.E. Marino is the immediate past chair of the American Heart Association Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) Council, and was not involved in the study.