Investigators conducted a cross-sectional analysis at a tertiary referral outpatient clinic for adults with congenital heart disease. The sample comprised 45 consecutively recruited patients seen between January 1 and June 1, 2023; 21 had a documented history of anxiety disorders in their medical record and 24 did not. Inclusion required age 18 or older and a confirmed CHD diagnosis established from medical records and prior imaging. Patients with severe psychiatric disorders other than anxiety, recent acute cardiovascular events, cognitive impairment precluding questionnaire completion, or insufficient medical-record information were excluded.
The study team used validated, self-administered measures completed during routine visits. Health-related quality of life was assessed with the EuroQol-5D-3L and the EQ visual analogue scale (EQ-VAS). Self-esteem was measured with the Rosenberg Self-Esteem Scale (RSES). Anxiety symptoms were quantified using the STAI (state and trait subscales). Depressive symptoms were measured with the BDI-II. Investigators recorded demographic, clinical, psychiatric, and socioeconomic variables from structured interviews and the electronic medical record. The authors noted that information on who made the anxiety diagnosis, diagnostic criteria used, and precise timing of diagnosis was not consistently available and therefore not used in analyses.
Mean age differed modestly between groups (35 ± 9 years with documented anxiety history versus 31 ± 11 years without); this difference was not statistically significant. Sex distribution approached significance, with a smaller proportion of males among those with documented anxiety history. The cohort with documented anxiety history had a higher frequency of New York Heart Association (NYHA) functional class II–IV compared with controls. Measures such as the number of prior cardiac surgeries, presence of implantable cardiac devices, and CHD complexity were captured and used in adjusted models, but specific numeric breakdowns beyond those reported in the manuscript are not replicated here.
In unadjusted comparisons, participants with a documented anxiety history reported greater limitations in usual activities on the EQ-5D-3L and higher scores on the EQ-5D anxiety/depression domain. These participants also rated their overall health worse on the EQ-VAS. Trait anxiety scores on the STAI were higher in the documented-anxiety group. Depressive symptom severity, measured by the BDI-II, was substantially greater in the documented-anxiety group (median 19) compared with the no-anxiety group (median 3). Self-esteem measured by the RSES was reported higher in the documented-anxiety group in unadjusted testing, a finding the authors describe and analyze further.
Investigators used multivariable logistic regression adjusted for sex, NYHA functional class, and CHD complexity to examine which psychosocial measures were independently associated with a documented history of anxiety disorders. After adjustment, higher BDI-II scores remained positively associated with a documented anxiety diagnosis (reported odds ratio 1.14 per BDI-II point, 95% CI 1.05–1.28). By contrast, higher EQ-VAS scores were inversely associated with a documented anxiety history (reported OR 0.64, 95% CI 0.38–0.97), indicating poorer self-rated health among those with documented anxiety. STAI-State, STAI-Trait, and RSES did not show significant independent associations with documented anxiety history in the adjusted models reported by the authors. The authors also tested moderate depression using univariable logistic regression and found no statistically significant associations with the variables assessed in that analysis.
The authors acknowledged key limitations rooted in the study design and the medical-record–based exposure. The number of participants was limited (45 total), and the cross-sectional design prevents causal inference regarding the temporal relationship between anxiety history and current psychosocial status. The electronic record did not consistently provide the diagnosing clinician, diagnostic criteria, or date of the anxiety diagnosis; consequently, investigators could not account for diagnostic setting, treatment history, or duration of anxiety in the analyses. Data sharing is restricted under the institutional ethics approval; the authors note that the dataset is available upon reasonable request to the Research Ethics Committee. These missing diagnostic and treatment details remain unanswered within the reported data and represent gaps for future investigation.