Association Between Congenital Heart Disease Complexity, Mental Health Conditions and Opioid Use Disorder

As patients with congenital heart disease (CHD) survive into adulthood, there is concern that more complex diagnoses, with possible repeat perioperative opioid exposures, may be associated with increased risk of opioid-related harms, including development of an opioid use disorder (OUD).

The purpose of this study was to determine if OUD prevalence is higher among patients with more surgically complex CHD diagnoses.

We conducted a national retrospective cohort study among CHD patients aged 15 to 64 years between 2012 and 2022. Using clinical consensus, diagnoses were categorized as simple biventricular, complex biventricular, and single ventricle physiology conditions. Our primary outcome was OUD prevalence. Secondary outcomes included history of overdose, substance use disorders (SUD), and mental health diagnoses. Outcomes were captured in medical claims using International Classification of Diseases (Ninth Revision and Tenth Revision) diagnosis codes. We utilized multivariable logistic regression models to assess the association between CHD complexity, patient characteristics, and outcomes.

Among 73,046 CHD patients, the median age was 43.0 (Q1-Q3: 29.0-56.0) years, and 39,795 (54.5%) were female. OUD prevalence was 3.6% (n = 1,994 of 55,335) among simple biventricular patients, 1.9% (n = 269 of 14,077) among complex biventricular patients, and 3.5% (n = 126 of 3,634) among single ventricle physiology patients. Trends in overdose and SUD prevalence were similar. Simple biventricular and single ventricle patients had increased anxiety and mood disorder prevalence.

Patients with more complex diagnoses had the lowest OUD/SUD prevalence. Comorbid mood and anxiety disorders were strongly associated with these outcomes. Findings support the need for additional research and routine mental health and OUD/SUD screening for CHD patients.