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Hebson C, Book W, Elder RW, Ford R, Jokhadar M, Kanter K, Kogon B, Kovacs AH, Levit RD, Lloyd M, Maher K, Reshamwala P, Rodriguez F, Romero R, Tejada T, Marie Valente A, Veldtman G, McConnell M. “Frontiers in Fontan failure: A summary of conference proceedings”. CONGENIT HEART DIS 2016; 12:6-16. [DOI: 10.1111/chd.12407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/24/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Camden Hebson
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
| | - Wendy Book
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Robert W. Elder
- Division of Cardiology; Department of Medicine, Yale University; New Haven CT
| | - Ryan Ford
- Division of Gastroenterology; Department of Medicine, Emory University; Atlanta GA
| | - Maan Jokhadar
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Kirk Kanter
- Division of Cardiothoracic Surgery; Department of Surgery, Emory University; Atlanta GA
| | - Brian Kogon
- Division of Cardiothoracic Surgery; Department of Surgery, Emory University; Atlanta GA
| | - Adrienne H. Kovacs
- Division of Cardiology; Department of Medicine, Oregon Health and Science University; Portland OR
| | - Rebecca D. Levit
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Michael Lloyd
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Kevin Maher
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
| | - Preeti Reshamwala
- Division of Gastroenterology; Department of Medicine, Emory University; Atlanta GA
| | - Fred Rodriguez
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
| | - Rene Romero
- Division of Pediatric Gastroenterology; Department of Pediatrics, Emory University; Atlanta GA
| | - Thor Tejada
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Anne Marie Valente
- Division of Cardiology; Department of Medicine, Harvard University; Boston MA
| | - Gruschen Veldtman
- Division of Pediatric Cardiology; Department of Pediatrics, University of Cincinnati; Cincinnati OH
| | - Michael McConnell
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
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152
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Gurvitz M, Burns KM, Brindis R, Broberg CS, Daniels CJ, Fuller SMPN, Honein MA, Khairy P, Kuehl KS, Landzberg MJ, Mahle WT, Mann DL, Marelli A, Newburger JW, Pearson GD, Starling RC, Tringali GR, Valente AM, Wu JC, Califf RM. Emerging Research Directions in Adult Congenital Heart Disease: A Report From an NHLBI/ACHA Working Group. J Am Coll Cardiol 2016; 67:1956-64. [PMID: 27102511 DOI: 10.1016/j.jacc.2016.01.062] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/21/2015] [Accepted: 01/25/2016] [Indexed: 12/20/2022]
Abstract
Congenital heart disease (CHD) is the most common birth defect, affecting about 0.8% of live births. Advances in recent decades have allowed >85% of children with CHD to survive to adulthood, creating a growing population of adults with CHD. Little information exists regarding survival, demographics, late outcomes, and comorbidities in this emerging group, and multiple barriers impede research in adult CHD. The National Heart, Lung, and Blood Institute and the Adult Congenital Heart Association convened a multidisciplinary working group to identify high-impact research questions in adult CHD. This report summarizes the meeting discussions in the broad areas of CHD-related heart failure, vascular disease, and multisystem complications. High-priority subtopics identified included heart failure in tetralogy of Fallot, mechanical circulatory support/transplantation, sudden cardiac death, vascular outcomes in coarctation of the aorta, late outcomes in single-ventricle disease, cognitive and psychiatric issues, and pregnancy.
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Affiliation(s)
- Michelle Gurvitz
- Harvard Medical School, Boston Adult Congenital Heart and Pulmonary Hypertension Program, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
| | - Kristin M Burns
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | | | | | | | - Paul Khairy
- Universite de Montreal, Montreal, Quebec, Canada
| | | | - Michael J Landzberg
- Harvard Medical School, Boston Adult Congenital Heart and Pulmonary Hypertension Program, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Ariane Marelli
- McGill University Health Center, Montreal, Quebec, Canada
| | - Jane W Newburger
- Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Gail D Pearson
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | - Anne Marie Valente
- Harvard Medical School, Boston Adult Congenital Heart and Pulmonary Hypertension Program, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph C Wu
- Stanford University School of Medicine, Palo Alto, California
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154
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Kasparian NA, Winlaw DS, Sholler GF. “Congenital heart health”: how psychological care can make a difference. Med J Aust 2016; 205:104-7. [DOI: 10.5694/mja16.00392] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Nadine A Kasparian
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
- University of New South Wales, Sydney, NSW
| | - David S Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Gary F Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
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155
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Abstract
Patients with CHD are vulnerable to psychiatric disorders. The present study compared baseline depressive symptoms between adolescents with CHD and community adolescents, and also assessed the development and persistence of depressive symptoms in patients. We examined the implications of persistent depressive symptoms towards quality of life and patient-reported health. In total, 296 adolescents with CHD participated in a four-wave longitudinal study, with 9-month intervals, and completed measures of depressive symptoms - Center for Epidemiologic Studies Depression Scale (CES-D) - at time points one to four and of quality of life - linear analogue scale (LAS) - and patient-reported health - LAS and Pediatric Quality of Life Inventory - at T (time) 4. Information about diagnosis, disease complexity, and previous heart surgery was collected from medical records. At T1, 278 patients were matched 1:1 with community adolescents, based on sex and age. The findings of this study indicate that patients scored significantly lower on depressive symptoms compared with community adolescents. Depressive symptoms in the total patient sample were stable over time and were unrelated to disease complexity. Based on conventional cut-off scores of the CES-D, substantial individual differences existed in the extent to which depressive symptoms persisted over time: 12.2% of the patients reported elevated depressive symptoms at minimally three out of the four time points. Especially physical functioning, cardiac symptoms, and patient-reported health at T4 were predicted by persistent depressive symptoms, even when controlling for the level of depressive symptoms at T4. Our findings indicate that those involved in the care of adolescents with CHD should remain vigilant to persistent depressive symptoms and arrange timely referral to mental healthcare services.
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156
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Prevalence and Correlates of Post-traumatic Stress Disorder in Adults With Congenital Heart Disease. Am J Cardiol 2016; 117:853-7. [PMID: 26803381 DOI: 10.1016/j.amjcard.2015.11.065] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with adverse outcomes and increased mortality in cardiac patients. No studies have examined PTSD in the adult congenital heart disease (ACHD) population. The objectives of this study were to assess the prevalence of self-reported symptoms of PTSD in patients with ACHD and explore potential associated factors. Patients were enrolled from an outpatient ACHD clinic and completed several validated measures including the Impact of Event Scale-Revised, PTSD Checklist-Civilian Version, and the Hospital Anxiety and Depression Scale. Clinical data were abstracted through medical data review. A total of 134 participants (mean age 34.6 ± 10.6; 46% men) were enrolled. Of the 127 participants who completed the Impact of Event Scale-Revised, 14 (11%) met criteria for elevated PTSD symptoms specifically related to their congenital heart disease or treatment. Of the 134 patients who completed PTSD Checklist-Civilian Version, 27 (21%) met criteria for global PTSD symptoms. In univariate analyses, patients with congenital heart disease-specific PTSD had their most recent cardiac surgery at an earlier year (p = 0.008), were less likely to have attended college (p = 0.04), had higher rates of stroke or transient ischemic attack (p = 0.03), and reported greater depressive symptoms on the Hospital Anxiety and Depression Scale (7 vs 2, p <0.001). In multivariable analysis, the 2 factors most strongly associated with PTSD were depressive symptoms (p <0.001) and year of most recent cardiac surgery (p <0.03). In conclusion, PTSD is present in 11% to 21% of subjects seen at a tertiary referral center for ACHD. The high prevalence of PTSD in this complex group of patients has important implications for the medical and psychosocial management of this growing population.
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157
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Uzark K, Zak V, Shrader P, McCrindle BW, Radojewski E, Varni JW, Daniels K, Handisides J, Hill KD, Lambert LM, Margossian R, Pemberton VL, Lai WW, Atz AM. Assessment of Quality of Life in Young Patients with Single Ventricle after the Fontan Operation. J Pediatr 2016; 170:166-72.e1. [PMID: 26685073 PMCID: PMC4769899 DOI: 10.1016/j.jpeds.2015.11.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/12/2015] [Accepted: 11/05/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess self-reported quality of life (QOL) in a large multicenter cohort of adolescent and young adults surviving Fontan. STUDY DESIGN Cross-sectional. The Pediatric Quality of Life Inventory (PedsQL) was administered to 408 survivors of Fontan ages 13-25 years enrolled in the Pediatric Heart Network Fontan Follow-up Study. Subjects also completed either the Child Health Questionnaire (age <19 years) or Short Form Health Survey (age ≥ 19 years). PedsQL data were compared with matched controls without a chronic health condition. Correlations between the measures were examined. RESULTS Mean PedsQL scores for subjects receiving Fontan were significantly lower than those for the control group for physical and psychosocial QOL (P < .001). Overall, 45% of subjects receiving Fontan had scores in the clinically significant impaired range for physical QOL with 30% in the impaired range for psychosocial QOL. For each 1 year increase in age, the physical functioning score decreased by an average of 0.76 points (P = .004) and the emotional functioning score decreased by an average of 0.64 points (P = .03). Among subjects ≥19 years of age, the physical functioning score decreased by an average of 2 points for each year increase in age (P = .02). PedsQL scale scores were significantly correlated with conceptually related Child Health Questionnaire (P < .001) and Short Form Health Survey scores (P < .001). CONCLUSIONS Survivors of Fontan are at risk for significantly impaired QOL which may decline with advancing age. Routine assessment of QOL is essential to inform interventions to improve health outcomes. The PedsQL allowed QOL assessment from pediatrics to young adulthood. TRIAL REGISTRATION ClinicalTrials.gov: NCT00132782.
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Affiliation(s)
- Karen Uzark
- University of Michigan Mott Children's Hospital, Ann Arbor, MI.
| | - Victor Zak
- New England Research Institutes, Watertown, MA
| | | | - Brian W McCrindle
- University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Wyman W Lai
- Columbia University Medical Center, New York, NY
| | - Andrew M Atz
- Medical University of South Carolina, Charleston, SC
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158
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Ferguson M, Kovacs AH. An Integrated Adult Congenital Heart Disease Psychology Service. CONGENIT HEART DIS 2016; 11:444-451. [DOI: 10.1111/chd.12331] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Meaghan Ferguson
- Graduate Program in Psychology, York University; Toronto Ontario Canada
| | - Adrienne H. Kovacs
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto; Toronto Ontario Canada
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Budts W, Roos-Hesselink J, Rädle-Hurst T, Eicken A, McDonagh TA, Lambrinou E, Crespo-Leiro MG, Walker F, Frogoudaki AA. Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2016; 37:1419-27. [PMID: 26787434 DOI: 10.1093/eurheartj/ehv741] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | | | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences Cyprus University of Technology, Limassol, Cyprus
| | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Service, Hospital Universitario A Coruña, La Coruña, Spain
| | - Fiona Walker
- Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Alexandra A Frogoudaki
- Adult Congenital Heart Clinic, Second Cardiology Department, ATTIKON University Hospital and Athens University, Athens, Greece
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160
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Pike NA, Woo MA, Poulsen MK, Evangelista W, Faire D, Halnon NJ, Lewis AB, Kumar R. Predictors of Memory Deficits in Adolescents and Young Adults with Congenital Heart Disease Compared to Healthy Controls. Front Pediatr 2016; 4:117. [PMID: 27843890 PMCID: PMC5086579 DOI: 10.3389/fped.2016.00117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/11/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Adolescents and young adults with congenital heart disease (CHD) show a range of memory deficits, which can dramatically impact their clinical outcomes and quality of life. However, few studies have identified predictors of these memory changes. The purpose of this investigation was to identify predictors of memory deficits in adolescents and young adults with CHD after surgical palliation compared to healthy controls. METHOD One hundred fifty-six adolescents and young adults (80 CHD and 76 controls; age 14-21 years) were recruited and administered an instrument to assess memory [Wide Range Assessment of Memory and Learning Second Edition - general memory index (GMI) score] and completed questionnaires that measure anxiety, depression, sleepiness, health status, and self-efficacy. Descriptive and non-parametric statistics were used to assess group differences, and logistic regression to identify predictors of memory deficits. RESULTS CHD subjects consisted of 58% males, median age 17 years, 43% Hispanic, and medians of 2 previous heart surgeries and 14 years since last surgery. Memory deficits (GMI ≤ 85) were identified in 50% CHD compared to 4% healthy controls (median GMI 85 vs. 104, p < 0.001). Of GMI subscale medians, CHD subjects had significantly worse memory performance vs. healthy controls (verbal 88 vs. 105, p < 0.001; attention 88 vs. 109, p < 0.001; working memory 86 vs. 108, p < 0.001). No significant differences appeared between groups for visual memory. Multiple clinical and psychosocial factors were identified which were statistically different on bivariate analyses between the subjects with and without memory deficits. By multivariate analysis, male gender, number of surgeries, anxiety, and self-efficacy emerged as independent predictors of memory deficits. CONCLUSION Adolescents and young adults with CHD, more than a decade since their last surgery, show significant verbal, attention, and working memory deficits over controls. To enhance patient memory/self-care, clinicians should explore ways to reduce anxiety, improve self-efficacy, and increase use of visual patient education material, especially in CHD males.
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Affiliation(s)
- Nancy A Pike
- School of Nursing, University of California Los Angeles , Los Angeles, CA , USA
| | - Mary A Woo
- School of Nursing, University of California Los Angeles , Los Angeles, CA , USA
| | - Marie K Poulsen
- Division of General Pediatrics, Children's Hospital Los Angeles , Los Angeles, CA , USA
| | - Wendy Evangelista
- School of Nursing, University of California Los Angeles , Los Angeles, CA , USA
| | - Dylan Faire
- School of Nursing, University of California Los Angeles , Los Angeles, CA , USA
| | - Nancy J Halnon
- Division of Pediatric Cardiology, University of California Los Angeles , Los Angeles, CA , USA
| | - Alan B Lewis
- Division of Pediatric Cardiology, Children's Hospital Los Angeles , Los Angeles, CA , USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA; The Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
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161
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Abstract
BACKGROUND Despite an increasing prevalence of adults living with a CHD, little is known about the psychosocial impact of CHD. We sought to investigate the relative impact of disease severity and patients' perceptions about their condition on depression, anxiety, and quality of life over a period of a year. METHODS A total of 110 patients aged over 16 years completed an initial questionnaire containing measures for anxiety, depression, quality of life, and illness perceptions when they attended the Adult Congenital Heart Disease Clinic. Cardiologists rated the patients' disease severity and illness course. A year later, patients were invited to complete the same measures. Regression analyses were performed to determine the relative impact of illness perceptions and disease severity on psychological outcomes a year later. RESULTS At baseline, 23% of the study population had depressive symptoms and 30% had elevated trait anxiety. After controlling for associations with disease-related variables, illness perceptions explained 28% of the variance in depression, 40% anxiety, and 27% overall quality of life at baseline. Baseline illness perceptions bivariately predicted quality of life, cardiac anxiety, and depression 1 year later, and regression analyses controlling for other factors showed that they were significant predictors of outcomes 1 year later. CONCLUSION Symptoms of depression and anxiety are common among adults with CHD. Patients' illness perceptions are related to psychological outcomes, especially cross-sectionally. Future research could investigate whether an intervention to discuss patients' perceptions about their CHD can improve mental health and quality of life.
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Kovacs AH, Bandyopadhyay M, Grace SL, Kentner AC, Nolan RP, Silversides CK, Irvine MJ. Adult Congenital Heart Disease-Coping And REsilience (ACHD-CARE): Rationale and methodology of a pilot randomized controlled trial. Contemp Clin Trials 2015; 45:385-393. [PMID: 26546067 DOI: 10.1016/j.cct.2015.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION One-third of North American adults with congenital heart disease (CHD) have diagnosable mood or anxiety disorders and most do not receive mental health treatment. There are no published interventions targeting the psychosocial needs of patients with CHD of any age. We describe the development of a group psychosocial intervention aimed at improving the psychosocial functioning, quality of life, and resilience of adults with CHD and the design of a study protocol to determine the feasibility of a potential full-scale randomized controlled trial (RCT). METHODS/DESIGN Drawing upon our quantitative and qualitative research, we developed the Adult CHD-Coping And REsilience (ACHD-CARE) intervention and designed a feasibility study that included a 2-parallel arm non-blinded pilot RCT. Eligible participants (CHD, age ≥ 18 years, no planned surgery, symptoms suggestive of a mood and/or anxiety disorder) were randomized to the ACHD-CARE intervention or Usual Care (1:1 allocation ratio). The group intervention was delivered during eight 90-minute weekly sessions. Feasibility will be assessed in the following domains: (i) process (e.g. recruitment and retention), (ii) resources, (iii) management, (iv) scientific outcomes, and (v) intervention acceptability. DISCUSSION This study underscores the importance of carefully developing and testing the feasibility of psychosocial interventions in medical populations before moving to full-scale clinical trials. At study conclusion, we will be poised to make one of three determinations for a full-scale RCT: (1) feasible, (2) feasible with modifications, or (3) not feasible. This study will guide the future evaluation and provision of psychosocial treatment for adults with CHD.
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Affiliation(s)
- Adrienne H Kovacs
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, 5N-523, Toronto, ON M5G 2N2, Canada.
| | - Mimi Bandyopadhyay
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, 5N-523, Toronto, ON M5G 2N2, Canada
| | - Sherry L Grace
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, 5N-523, Toronto, ON M5G 2N2, Canada; York University, 4700 Keele St, Toronto, ON M3J1P3, Canada
| | - Amanda C Kentner
- School of Arts and Sciences, MCPHS University, 179 Longwood Ave, Boston, MA 02115, USA
| | - Robert P Nolan
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, 5N-523, Toronto, ON M5G 2N2, Canada
| | - Candice K Silversides
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, 5N-523, Toronto, ON M5G 2N2, Canada
| | - M Jane Irvine
- York University, 4700 Keele St, Toronto, ON M3J1P3, Canada
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164
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White KS, Pardue C, Ludbrook P, Sodhi S, Esmaeeli A, Cedars A. Cardiac Denial and Psychological Predictors of Cardiac Care Adherence in Adults With Congenital Heart Disease. Behav Modif 2015; 40:29-50. [DOI: 10.1177/0145445515613329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current study examined cardiac denial and psychological predictors (i.e., depression, anxiety) of health outcomes including medical nonadherence and physical health in a sample of 80 adults with congenital heart disease (ACHD). Results indicated that denial of impact was elevated in this patient group compared with reference groups, and denial was negatively associated with depression and anxiety at ps < .01. Results indicated that depression, anxiety, and denial predicted unique variance in medical nonadherence, and gender moderated the relationships between these psychological factors and nonadherence. For depression, men and women showed similar relationships between depression and nonadherence at high levels of depression; however, at low levels of depression (i.e., a more normal mood state), men were less adherent compared with women. For anxiety, men and women did not differ in adherence at low levels of anxiety; however, men experiencing high anxiety were less adherent compared with women experiencing high anxiety. Implications of this study are discussed including the role of gender and denial and the impact of denial functioning to reduce negative affect. Depression was the only significant predictor of physical functioning. Results of this study suggest that psychological interventions aimed at depression and anxiety may function differently across gender to improve patient medical adherence and improve physical functioning in ACHD.
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Affiliation(s)
| | | | - Philip Ludbrook
- Washington University School of Medicine, St. Louis, MO, USA
| | - Sandeep Sodhi
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Ari Cedars
- Washington University School of Medicine, St. Louis, MO, USA
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166
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LeMond L, Mai T, Broberg CS, Muralidaran A, Burchill LJ. Heart Failure in Adult Congenital Heart Disease: Nonpharmacologic Treatment Strategies. Cardiol Clin 2015; 33:589-98, viii-ix. [PMID: 26471822 DOI: 10.1016/j.ccl.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In early stages, heart failure (HF) in adult congenital heart disease (ACHD) remains an elusive diagnosis. Many ACHD patients seem well-compensated owing to chronic physical and psychological adaptations. HF biomarkers and cardiopulmonary exercise tests are often markedly abnormal, although patients report stable health and good quality of life. Treatment differs from acquired HF. Evidence for effective drug therapy in ACHD-related HF is lacking. Residual ventricular, valvular, and vascular abnormalities contribute to HF pathophysiology, leading to an emphasis on nonpharmacologic treatment strategies. This article reviews emerging perspectives on nonpharmacologic treatment strategies, including catheter-based interventions, surgical correction, and palliative care.
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Affiliation(s)
- Lisa LeMond
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Tuan Mai
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Craig S Broberg
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ashok Muralidaran
- Pediatric Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR 97239, USA
| | - Luke J Burchill
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239, USA.
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167
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Hays L. Transition to Adult Congenital Heart Disease Care: A Review. J Pediatr Nurs 2015; 30:e63-9. [PMID: 25704989 DOI: 10.1016/j.pedn.2015.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 01/07/2023]
Abstract
The population of adults with congenital heart disease (ACHD) has grown due to recent advances in surgical procedures. The survival rate to adulthood is now more than 95%. This review identifies current recommendations and status of ACHD management and treatment in the United States by examining comprehensive guidelines for management and transition and comparing them to the current state of the science. Successful transition from pediatric to adult care begins during the adolescent years, and prepares patients for management at an ACHD regional center utilizing multidisciplinary teams of ACHD specialists. Advocacy and research needs for the ACHD population persist.
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Affiliation(s)
- Laura Hays
- Arkansas Children's Hospital, Little Rock, AR.
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168
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Diller GP, Bräutigam A, Kempny A, Uebing A, Alonso-Gonzalez R, Swan L, Babu-Narayan SV, Baumgartner H, Dimopoulos K, Gatzoulis MA. Depression requiring anti-depressant drug therapy in adult congenital heart disease: prevalence, risk factors, and prognostic value. Eur Heart J 2015; 37:771-82. [PMID: 26314687 DOI: 10.1093/eurheartj/ehv386] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is prevalent in adults with congenital heart disease (ACHD), but limited data on the frequency of anti-depressant drug (ADD) therapy and its impact on outcome are available. METHODS AND RESULTS We identified all ACHD patients treated with ADDs between 2000 and 2011 at our centre. Of 6162 patients under follow-up, 204 (3.3%) patients were on ADD therapy. The majority of patients were treated with selective serotonin-reuptake inhibitors (67.4%), while only 17.0% of patients received tricyclic anti-depressants. Twice as many female patients used ADDs compared with males (4.4 vs. 2.2%, P < 0.0001). The percentage of patients on ADDs increased with disease complexity (P < 0.0001) and patient age (P < 0.0001). Over a median follow-up of 11.1 years, 507 (8.2%) patients died. After propensity score matching, ADD use was found to be significantly associated with worse outcome in male ACHD patients [hazard ratio 1.44 (95% confidence interval 1.17-1.84)]. There was no evidence that this excess mortality was directly related to ADD therapy, QT-prolongation, or malignant arrhythmias. However, males taking ADDs were also more likely to miss scheduled follow-up appointments compared with untreated counterparts, while no such difference in clinic attendance was seen in females. CONCLUSIONS The use of ADD therapy in ACHD relates to gender, age, and disease complexity. Although, twice as many female patients were on ADDs, it were their male counterparts, who were at increased mortality risk on therapy. Furthermore, males on ADDs had worse adherence to scheduled appointments suggesting the need for special medical attention and possibly psychosocial intervention for this group of patients.
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Affiliation(s)
- Gerhard-Paul Diller
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
| | - Andrea Bräutigam
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Anselm Uebing
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Rafael Alonso-Gonzalez
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Lorna Swan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonya V Babu-Narayan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
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Bordin G, Padalino MA, Perentaler S, Castaldi B, Maschietto N, Michieli P, Crepaz R, Frigo AC, Vida VL, Milanesi O. Clinical Profile and Quality of Life of Adult Patients After the Fontan Procedure. Pediatr Cardiol 2015; 36:1261-9. [PMID: 25828147 DOI: 10.1007/s00246-015-1156-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 03/24/2015] [Indexed: 11/29/2022]
Abstract
Increasingly, more patients with univentricular heart reach adulthood. Therefore, long-term psychological features are an important concern. The aim of this study was to evaluate the clinical and psychological profile of post-Fontan adult patients and to identify the most significant determinants of quality of life. In this retrospective cross-sectional study, we reviewed the surgical and medical history of post-Fontan adult patients. Patients underwent a 24-h electrocardiogram, echocardiography and exercise testing. Self-report questionnaires were used to assess the Work Ability Index, quality of life (Satisfaction with Life Scale), perceived health status (SF-36 questionnaire), coping strategies (Brief Cope questionnaire) and presence of mood disorders (Hospital Anxiety and Depression Scale). Thirty-nine patients aged between 18 and 48 years (mean 27.5 years) were enrolled. The mean follow-up was 21.5 years. Most patients were unmarried (82.9 %), had a high school diploma (62.9 %) and were employed (62.9 %). Twenty-nine patients (82.3 %) had at least one long-term complication. The median single ventricle ejection fraction was 57 %, and the median maximal oxygen consumption was 26.8 ml/min/kg. This population tended to be anxious and to use adaptive coping strategies. Quality of life was perceived as excellent or good in 57.2 % of cases and was not related to either cardiac function or exercise capacity. Both quality of life and SF-36 domains were related to the Work Ability Index. This cohort of post-Fontan adult patients enjoyed a good quality of life irrespective of disease severity.
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Affiliation(s)
- Giulia Bordin
- Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy,
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Moceri P, Goossens E, Hascoet S, Checler C, Bonello B, Ferrari E, Acar P, Fraisse A. From adolescents to adults with congenital heart disease: the role of transition. Eur J Pediatr 2015; 174:847-54. [PMID: 25957970 DOI: 10.1007/s00431-015-2557-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 03/29/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Improved surgical care during the last decades, together with advances in medical management, led to a remarkable increase in survival of patients with congenital heart disease (CHD). However, aging of the CHD population brings new challenges, and loss of follow-up of adolescents and adults with CHD is a major concern. It is crucial to optimize the transfer of patients with CHD from paediatric to adult health care services to prevent loss to follow-up. The transition process plays a central role in the future health and follow-up of the patient. The aim of this review is to explain and discuss the clinical impact of the transition process in adolescents with CHD. We will also discuss specific CHD adolescents' problems. CONCLUSION Adolescence is a crucial phase for the formation of the personality. Understanding and acceptance of the responsibility for health at this stage through a transition process with a multidisciplinary team will determine the quality of future medical follow-up and probably limit psychosocial issues in their adult life. WHAT IS KNOWN • Aging of the congenital heart disease population brings new challenges to the organisation of care. • Loss of follow-up is a major concern for patients with congenital heart disease. What is new: • The quality of a formal transition process during adolescence will determine future outcomes in patients with congenital heart disease.
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Affiliation(s)
- Pamela Moceri
- Cardiology Department, Pasteur University Hospital, Nice, France,
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171
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Khan M, Monaghan M, Klein N, Ruiz G, John AS. Associations among Depression Symptoms with Alcohol and Smoking Tobacco Use in Adult Patients with Congenital Heart Disease. CONGENIT HEART DIS 2015; 10:E243-9. [PMID: 26108339 DOI: 10.1111/chd.12282] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Adult congenital heart disease (ACHD) patients have high rates of untreated depression and anxiety disorders. We evaluated associations among self-reported depression symptoms and alcohol/smoking tobacco use. METHODS From 2009 to 2013, 202 ACHD patients (45% male) completed questionnaires on depressive symptoms, anxiety symptoms, and substance use as part of routine clinical care. Data were collected by retrospective chart review. RESULTS Mean age was 31 ± 10 years, 21% reported often feeling depressed and 33% reported feeling nervous or anxious. Sixty-one percent of patients reported some alcohol intake; 25% reported current or previous smoking tobacco use. Patients with depressive symptoms were 3× as likely to report drinking alcohol (OR 2.89; 95% CI 1.29-6.5) and 5× more likely to report smoking tobacco use (OR 5.17; 95% CI 1.49-17.87). Fourteen percent of patients were prescribed antidepressant/antianxiety medications; 43% of patients on medication reported depressive symptoms. In patients reporting symptoms, those who consumed alcohol were less likely to be on antidepressant/antianxiety medications (21%) than those who did not consume alcohol (56%). CONCLUSION Self-reported depressive symptoms are associated with increased alcohol and smoking tobacco use by ACHD patients. Alcohol use may be a means of self-medicating for untreated depression, but further investigation is needed. Risk factors, including depressive symptoms and substance use, should be routinely assessed and addressed in ACHD patients.
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Affiliation(s)
- Munziba Khan
- Children's National Heart Institute, Children's National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - Maureen Monaghan
- Center for Translational Science, Children's National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - Nancy Klein
- Children's National Heart Institute, Children's National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - George Ruiz
- Children's National Heart Institute, Children's National Health System, George Washington University School of Medicine, Washington, DC, USA.,Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Anitha S John
- Children's National Heart Institute, Children's National Health System, George Washington University School of Medicine, Washington, DC, USA.,Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Bhatt AB, Foster E, Kuehl K, Alpert J, Brabeck S, Crumb S, Davidson WR, Earing MG, Ghoshhajra BB, Karamlou T, Mital S, Ting J, Tseng ZH. Congenital Heart Disease in the Older Adult. Circulation 2015; 131:1884-931. [DOI: 10.1161/cir.0000000000000204] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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173
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Eslami B, Macassa G, Sundin Ö, Khankeh HR, Soares JJF. Style of coping and its determinants in adults with congenital heart disease in a developing country. CONGENIT HEART DIS 2015; 9:349-60. [PMID: 25247217 DOI: 10.1111/chd.12150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies. DESIGN The study has a cross-sectional case-control design. SETTING The study was conducted in two university-affiliated heart hospitals in Tehran, Iran. PATIENTS The participants comprised 347 persons (18-64 years) with and 353 individuals without congenital heart disease, matched by gender and age. OUTCOME MEASURES Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group. RESULTS The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables. CONCLUSIONS The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.
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174
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Malpas TM, George SM, Kaisar JM, Radford DJ. A retrospective study of judicial encounters of young adults with congenital heart disease. J Health Psychol 2015; 21:2409-19. [PMID: 25869728 DOI: 10.1177/1359105315578301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Young people with congenital heart disease are often marginalised and may compensate for restricted physical and social abilities by substance abuse or risk-taking behaviour. We report on the judicial encounters of patients in an Adult Congenital Heart unit. Fifteen patients had court appearances and all were male. Seven served jail sentences, including four indigenous adolescents. All had multiple interventions for their cardiac conditions and four are now deceased. The majority of patients had mental health issues and substance misuse. These patients need psychological and medical support, and help with judicial authorities. Recommendations for ongoing care are provided.
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Affiliation(s)
| | | | | | - Dorothy J Radford
- The Prince Charles Hospital, Australia The University of Queensland, Australia
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175
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Bedair R, Babu-Narayan SV, Dimopoulos K, Quyam S, Doyle AM, Swan L, Gatzoulis MA, Wong T. Acceptance and psychological impact of implantable defibrillators amongst adults with congenital heart disease. Int J Cardiol 2015; 181:218-24. [DOI: 10.1016/j.ijcard.2014.12.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 11/14/2014] [Accepted: 12/01/2014] [Indexed: 12/01/2022]
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176
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Transitioning youth with congenital heart disease from pediatric to adult health care. J Pediatr 2015; 166:15-9. [PMID: 25449216 DOI: 10.1016/j.jpeds.2014.09.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/21/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022]
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177
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Awaad MI, Darahim KE. Depression and anxiety in adolescents with congenital heart disease. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000457325.90630.4f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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178
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Nasr VG, Kussman BD. Advances in the Care of Adults With Congenital Heart Disease. Semin Cardiothorac Vasc Anesth 2014; 19:175-86. [DOI: 10.1177/1089253214563989] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The significant decline in mortality among children and adolescents with congenital heart disease (CHD) is associated with an increasing prevalence of CHD in adults, particularly those with moderate to severe defects. As a significant percentage of adolescents and young adults are lost to follow-up in the transition from pediatric to adult care, they may present for elective procedures with substantial CHD-associated morbidity. In addition to the specific cardiac defect, the procedures performed, and the current pathophysiological status, several factors should be considered when managing the adult with CHD. These include the type of setting (adult vs pediatric institution); surgeon (pediatric vs adult cardiac surgeon); coexisting diseases associated with CHD, such as coronary artery disease, hepatic dysfunction, renal dysfunction, cerebrovascular accidents, myopathy, and coagulation disorders; acquired diseases of aging; pregnancy; and psychosocial functioning. The current status of the management of common and important congenital cardiac defects is also described.
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179
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Apers S, Kovacs AH, Luyckx K, Alday L, Berghammer M, Budts W, Callus E, Caruana M, Chidambarathanu S, Cook SC, Dellborg M, Enomoto J, Eriksen K, Fernandes SM, Jackson JL, Johansson B, Khairy P, Kutty S, Menahem S, Rempel G, Sluman MA, Soufi A, Thomet C, Veldtman G, Wang JK, White K, Moons P. Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): rationale, design, and methods. Int J Cardiol 2014; 179:334-42. [PMID: 25464481 DOI: 10.1016/j.ijcard.2014.11.084] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/24/2014] [Accepted: 11/06/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) are inconsistent and vary across the world. Better understanding of PROs and their differences across cultural and geographic barriers can best be accomplished via international studies using uniform research methods. The APPROACH-IS consortium (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study) was created for this purpose and investigates PROs in adults with CHD worldwide. This paper outlines the project rationale, design, and methods. METHODS/DESIGN APPROACH-IS is a cross-sectional study. The goal is to recruit 3500-4000 adults with CHD from 15 countries in five major regions of the world (Asia, Australia, Europe, North and South America). Self-report questionnaires are administered to capture information on PRO domains: (i) perceived health status (12-item Short-form Health Survey & EuroQOL-5D); (ii) psychological functioning (Hospital Anxiety and Depression Scale); (iii) health behaviors (Health-Behavior Scale-Congenital Heart Disease); and (iv) quality of life (Linear Analog Scale & Satisfaction With Life Scale). Additionally, potential explanatory variables are assessed: (i) socio-demographic variables; (ii) medical history (chart review); (iii) sense of coherence (Orientation to Life Questionnaire); and (iv) illness perceptions (Brief Illness Perception Questionnaire). Descriptive analyses and multilevel models will examine differences in PROs and investigate potential explanatory variables. DISCUSSION APPROACH-IS represents a global effort to increase research understanding and capacity in the field of CHD, and will have major implications for patient care. Results will generate valuable information for developing interventions to optimize patients' health and well-being. REGISTRATION ClinicalTrials.gov: NCT02150603.
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Affiliation(s)
- Silke Apers
- KU Leuven - University of Leuven, Department of Public Health and Primary Care, B-3000 Leuven, Belgium
| | - Adrienne H Kovacs
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Koen Luyckx
- KU Leuven - University of Leuven, School Psychology and Child and Adolescent Development, B-3000 Leuven, Belgium
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Malin Berghammer
- The Sahlgrenska Academy at University of Gothenburg, Institute of Medicine, Gothenburg, Sweden
| | - Werner Budts
- KU Leuven - University of Leuven, University Hospitals Leuven, Division of Congenital and Structural Cardiology, B-3000 Leuven, Belgium
| | - Edward Callus
- Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato, Milan, Italy
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | | | - Stephen C Cook
- Adult Congenital Heart Disease Center, Heart Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Mikael Dellborg
- The Sahlgrenska Academy at University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra and Institute for Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | | | - Susan M Fernandes
- Stanford University, Department of Pediatrics and Medicine, Division of Pediatric Cardiology and Cardiovascular Medicine, Palo Alto, CA, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bengt Johansson
- Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Shelby Kutty
- University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE, USA
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Gwen Rempel
- Northern Alberta Adult Congenital Heart Clinic, University of Alberta, Edmonton, Canada
| | - Maayke A Sluman
- Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands
| | | | - Corina Thomet
- University Hospital Bern, Center for Congenital Heart Disease, Bern, Switzerland
| | | | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Kamila White
- Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Philip Moons
- KU Leuven - University of Leuven, Department of Public Health and Primary Care, B-3000 Leuven, Belgium; The Sahlgrenska Academy at University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
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180
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Schoormans D, Sprangers MAG, van Melle JP, Pieper PG, van Dijk APJ, Sieswerda GT, Hulsbergen-Zwarts MS, Plokker THWM, Brunninkhuis LGH, Vliegen HW, Mulder BJM. Clinical and psychological characteristics predict future healthcare use in adults with congenital heart disease. Eur J Cardiovasc Nurs 2014; 15:72-81. [DOI: 10.1177/1474515114555819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/25/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Dounya Schoormans
- Department of Medical Psychology, Academic Medical Centre, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, the Netherlands
| | | | - Joost P van Melle
- Department of Cardiology, University Medical Centre Groningen, the Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Medical Centre Groningen, the Netherlands
| | - Arie PJ van Dijk
- Department of Cardiology, Radboud University Nijmegen Medical Centre, the Netherlands
| | | | | | | | | | | | - Barbara JM Mulder
- Department of Cardiology, Academic Medical Centre, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, the Netherlands
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181
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Abstract
AIMS The aim of this study was to assess the quality of life, psychiatric morbidity, and the psychosocial adjustment of adolescents and young adults with CHD, and determine which variables play a role in buffering stress and promoting resilience and which ones have a detrimental effect; and to investigate the situation on school performance and failures, social and family support, physical limitations, and body image of these patients. METHODS The study enrolled 137 CHD patients (79 male), with age ranging from 12 to 26 years old (M=17.60±3.450 years). The patients were interviewed regarding social support, family educational style, self-image, demographic information, and physical limitations. They responded to questions in a standardised psychiatric interview (SADS-L) and completed self-reported questionnaires for the assessment of quality of life (WHOQOL-BREF) and psychosocial adjustment (YSR/ASR). RESULTS We found a 19.7% lifetime prevalence of psychopathology in our patients (27.6% in female and 13.9% in male). Of them, 48% had retentions in school (M=1.61 year±0.82). The perception of quality of life in CHD patients is better compared with the Portuguese population in the social relationships and environmental dimensions. However, it is worse in complex forms of CHD than in moderate-to-mild ones, in cyanotic versus acyanotic patients, in moderate-to-severe versus mild residual lesions, in patients submitted versus those not submitted to surgery, in patients with versus without physical limitations, and patients who have need for medication versus those who do not. Social support is very important in improving quality of life of patients in all dimensions as well as academic performance. CONCLUSIONS Female patients and patients with poor academic performance and poor social support have worse psychosocial adjustment and perception of quality of life.
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182
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Bruckert E, Saheb S, Bonté JR, Coudray-Omnès C. Daily life, experience and needs of persons suffering from homozygous familial hypercholesterolaemia: Insights from a patient survey. ATHEROSCLEROSIS SUPP 2014; 15:46-51. [DOI: 10.1016/j.atherosclerosissup.2014.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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183
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Long-term psychosocial outcome of adults with tetralogy of Fallot and transposition of the great arteries: a historical comparison. Cardiol Young 2014; 24:593-604. [PMID: 23835118 DOI: 10.1017/s104795111300067x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To make a historical comparison on the long-term psychosocial outcome of cardiothoracic surgery during childhood. METHODS Adult patients operated for tetralogy of Fallot or transposition of the great arteries between 1980 and 1990 (recent sample) were compared with patients who underwent surgery and were investigated 10 years earlier (historical sample). In addition, atrial switch and arterial switch patients within the recent sample were compared. Psychosocial functioning was measured using standardised, validated psychological questionnaires. RESULTS Although the recent sample of patients overall shows a favourable quality of life, impairments were found in income, living conditions, relationships, offspring, and occupational level. Compared with the historical sample, the recent sample showed no significant improvements on psychosocial functioning, except for a better educational level. The amount of educational problems, such as learning difficulties, was still high compared with normative data. Recently operated patients with transposition of the great arteries (arterial switch) scored significantly better on the Short Form-36 vitality scale (p = 0.02) compared with historical patients with transposition of the great arteries (atrial switch). CONCLUSIONS Despite improvements in medical treatment over the past few decades, hardly any change was found in the psychosocial outcome of the recent patient sample compared with the historical patient sample. In particular, the percentage of patients needing special education and showing learning problems remained high, whereas income was low compared with normative data.
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184
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Kim GB. Psychosocial adjustment and quality of life of adolescents and adults with congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2014; 57:257-63. [PMID: 25076970 PMCID: PMC4115066 DOI: 10.3345/kjp.2014.57.6.257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/16/2014] [Indexed: 11/27/2022]
Abstract
The incidence of people living with congenital heart disease (CHD) has been increasing every year owing to remarkable advances in surgical and catheter intervention techniques and devices, and improved knowledge of critical care for patients with CHD. However, these patients continue to face physical, psychosocial, and environmental challenges, and a number of studies have shown higher rates of depression and anxiety disorders than the general population. To improve psychosocial functioning and quality of life for adults with CHD, health care providers are recommended to inform CHD patients of an accurate diagnosis, and overall treatment process, beginning in adolescence to facilitate a smooth transition from adolescence to adulthood. Active cooperation with psychiatrists, psychologists, social workers, chaplains, and family members is highly recommended to help CHD patients feel normal and optimistic and to promote good social interactions, close family relationships, and a strong sense of coherence.
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Affiliation(s)
- Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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185
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Kourkoveli P, Rammos S, Parissis J, Maillis A, Kremastinos D, Paraskevaidis I. Depressive Symptoms in Patients with Congenital Heart Disease: Incidence and Prognostic Value of Self-Rating Depression Scales. CONGENIT HEART DIS 2014; 10:240-7. [DOI: 10.1111/chd.12200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Panagiota Kourkoveli
- Department of Pediatric Cardiology and Adult Congenital Heart Disease; Onassis Cardiac Surgery Center; Athens Greece
| | - Spyros Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease; Onassis Cardiac Surgery Center; Athens Greece
| | - John Parissis
- Department of Cardiology; Attikon Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Antonis Maillis
- Department of Pediatric Cardiology and Adult Congenital Heart Disease; Onassis Cardiac Surgery Center; Athens Greece
- Department of Psychiatry; Aeginitio Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Dimitrios Kremastinos
- Department of Cardiology; Attikon Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Ioannis Paraskevaidis
- Department of Cardiology; Attikon Hospital; National and Kapodistrian University of Athens; Athens Greece
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186
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The impact of actual and perceived disease severity on pre-operative psychological well-being and illness behaviour in adult congenital heart disease patients. Cardiol Young 2014; 24:275-82. [PMID: 23534397 DOI: 10.1017/s1047951113000218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate whether the objective medical parameters related to congenital heart disease and patients' ratings of cardiac disease severity were related to psychological well-being and illness behaviour during the pre-operative period. METHODS A total of 143 patients (63 male patients; 16-73 years old) with congenital heart disease evaluated the severity of their cardiac condition using a numerical rating scale ranging from 0, indicating the least severe condition, to 100, indicating the most severe condition. Psychological well-being was assessed using the Psychological General Well-Being Index (total score ≤ 60 indicating severe distress) and illness behaviour using the Illness Behavior Questionnaire. RESULTS Pre-operative psychological well-being was not related to the objective medical parameters reflecting cardiac disease severity. In contrast, total psychological well-being scores correlated significantly with patients' subjective ratings of disease severity (p < 0.001). When compared with the reference values from the Italian population, the mean scores of the patients on psychological well-being were similar. As regards the Illness Behavior Questionnaire, the scores on denial were higher and those on hypochondria were lower compared with other hospitalised patients. CONCLUSIONS This study shows that the perception of cardiac disease severity, and not the medical parameters in congenital heart disease, is related to the patients' pre-operative psychological state. Thus, more importance needs to be given to assessing the patients' pre-operative perception and psychological state independently of cardiac severity. Targeted interventions with regard to the cardiac condition are recommended.
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187
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Yi JJ, Tang SX, McDonald-McGinn DM, Calkins ME, Whinna DA, Souders MC, Zackai EH, Goldmuntz E, Gaynor JW, Gur RC, Emanuel BS, Gur RE. Contribution of congenital heart disease to neuropsychiatric outcome in school-age children with 22q11.2 deletion syndrome. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:137-47. [PMID: 24265253 PMCID: PMC4154196 DOI: 10.1002/ajmg.b.32215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/04/2013] [Indexed: 01/16/2023]
Abstract
Children with 22q11.2 deletion syndrome (22q11DS) present with congenital heart disease (CHD) and high prevalence of psychiatric disorders and neurocognitive deficits. Although CHD has been implicated in neurodevelopment, its role in the neuropsychiatric outcome in 22q11DS is poorly understood. We investigated whether CHD contributes to the high prevalence of psychiatric disorders and neurocognitive impairments in 22q11DS. Fifty-four children ages 8-14 years with 22q11DS and 16 age-matched non-deleted children with CHD participated. They were assessed using semi-structured interviews and a Computerized Neurocognitive Battery. CHD status was assessed using available medical records. Prevalence of psychiatric disorders and cognitive profiles were compared among the groups. There were no significant differences between the prevalence of psychiatric disorders in the 22q11DS with and without CHD. In 22q11DS with CHD, the prevalence rates were 41% anxiety disorders, 37% ADHD and 71% psychosis spectrum. In 22q11DS without CHD, the rates were 33% anxiety disorders, 41% ADHD and 64% psychosis spectrum. In comparison, the non-deleted CHD group had lower rates of psychopathology (25% anxiety disorders, 6% ADHD, and 13% psychosis spectrum). Similarly, the 22q11DS groups, regardless of CHD status, had significantly greater neurocognitive deficits across multiple domains, compared to the CHD-only group. We conclude that CHD in this sample of children with 22q11.2DS does not have a major impact on the prevalence of psychiatric disorders and is not associated with increased neurocognitive deficits. These findings suggest that the 22q11.2 deletion status itself may confer significant neuropsychiatric vulnerability in this population.
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Affiliation(s)
- James J. Yi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Department of Child and Adolescent Psychiatry and Behavioral Science, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sunny X. Tang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donna M. McDonald-McGinn
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daneen A. Whinna
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret C. Souders
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine H. Zackai
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Goldmuntz
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James W. Gaynor
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beverly S. Emanuel
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Correspondence to: Raquel E. Gur, M.D., Ph.D., Neuropsychiatry section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 10th Floor Gates Pavilion, Philadelphia, PA 19104.
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188
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Abstract
Adolescents with congenital heart disease (CHD) are a rapidly growing population with complex medical needs and psychosocial challenges. Identity formation is an important developmental task accomplished during the teenage years. This article reviews different aspects of ongoing care that pertain to teenagers with CHD, with a particular focus on primary care issues and a summary of recommendations from various scientific societies. A successful smooth transition to the adult health care setting should achieve 2 important goals: to prevent loss of follow-up and to foster and encourage self-care behaviors.
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Affiliation(s)
- Pooja Gupta
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201-2119, USA.
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189
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Callus E, Quadri E, Ricci C, Passerini C, Tovo A, Pelissero G, Chessa M. Update on psychological functioning in adults with congenital heart disease: a systematic review. Expert Rev Cardiovasc Ther 2014; 11:785-91. [DOI: 10.1586/erc.13.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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190
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Psychosocial Functioning and Quality of Life in Adults with Congenital Heart Disease and Heart Failure. Heart Fail Clin 2014; 10:35-42. [DOI: 10.1016/j.hfc.2013.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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191
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Enomoto J, Nakazawa M. Negative Effect of Aging on Psychosocial Functioning of Adults With Congenital Heart Disease. Circ J 2014; 79:185-92. [DOI: 10.1253/circj.cj-14-0682] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Makoto Nakazawa
- Pediatric and Lifelong Congenital Cardiology Institute, Southern Tohoku General Hospital
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192
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Lane DA, Millane TA, Lip GYH. Psychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev 2013:CD004372. [PMID: 24163137 DOI: 10.1002/14651858.cd004372.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adult and adolescent congenital heart disease is increasing in prevalence as better medical care means more children are surviving to adulthood. People with chronic disease often also experience depression. There are several non-pharmacological treatments that might be effective in treating depression and improving quality of life for adults and young adults with congenital heart disease. The aim of this review was to assess the effects of treatments such as psychotherapy, cognitive behavioural therapies and talking therapies for treating depression in this population. OBJECTIVES To update the previous review on the effects (both harms and benefits) of psychological interventions for treating depression in young adults and adults with congenital heart disease. Psychological interventions include cognitive behavioural therapy, psychotherapy, or 'talking/counselling' therapy for depression. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2013), MEDLINE (OVID, 1946 to January week 4 2013), EMBASE (OVID, 1980 to 2013 week 05), PsycINFO (OVID, 1806 to January week 5 2013), the Database of Abstracts of Reviews of Effectiveness (DARE) on The Cochrane Library (Issue 1, 2013), BIOSIS (Thomson Reuters, 1969 to 21 February 2013), and CINAHL (January 1980 to February 2013) on 5 February 2013. We did not search abstracts from national and international cardiology and psychology conferences and dissertation abstracts for this update. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions with no intervention for people over 15 years with depression who have congenital heart disease. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts of studies that were potentially relevant to the review. We rejected studies that were clearly ineligible. Two review authors independently assessed the abstracts or full papers for inclusion criteria. We sought further information from the authors where papers contained insufficient information to make a decision about eligibility. MAIN RESULTS We did not identify any randomised controlled trials that met the inclusion criteria. AUTHORS' CONCLUSIONS Depression is common in people with congenital heart disease and can exacerbate the physical consequences of the illness. There are effective pharmacological and non-pharmacological treatments for depression, but we have not been able to identify any trials showing the effectiveness of non-pharmacological treatments. A well-designed randomised controlled trial is needed to assess the effects of psychological interventions for depression in congenital heart disease.
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Affiliation(s)
- Deirdre A Lane
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, UK, B18 7QH
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193
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Bang JS, Jo S, Kim GB, Kwon BS, Bae EJ, Noh CI, Choi JY. The mental health and quality of life of adult patients with congenital heart disease. Int J Cardiol 2013; 170:49-53. [PMID: 24139784 DOI: 10.1016/j.ijcard.2013.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 07/28/2013] [Accepted: 10/05/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND The quality of life (QoL) of adults with congenital heart disease (CHD) has gained significant interest. In addition to medical problems, many patients with CHD face psychosocial, educational, and behavioral challenges. However, few studies have examined the relationship between disease severity and QoL in adults with CHD. METHODS Eighty-five patients (50 men, 35 women) aged 20-52 years (median, 26.5 years) were enrolled. Patients underwent a QoL, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) survey. The scores were compared with those of age- and gender-matched population data according to the degree of underlying CHD. Disease severity was classified in relation to initial diagnosis, illness course, and current functional status (New York Heart Association [NYHA] class, ability index, CHD functional index, ventricular ejection fraction, and peak VO2). RESULTS There was no significant correlation between disease severity and current functional status assessed by BDI and BAI. Patients who stated that they were religious had better scores for resilience (p=0.031), physical QoL (p=0.008), and environmental QoL (p=0.025). Environmental QoL scores were higher in patients who fully understood their disease (p=0.004). Current NYHA functional class was associated with scores for psychological resilience. CONCLUSIONS CHD severity had a detrimental impact on resilience only when measured in terms of poor functional status. The initial diagnosis and course of the illness influence QoL and perceived health. Good psychosocial adaptation could be the result of close family relationships and involvement, making mental adjustment easier.
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Affiliation(s)
- Ji Seok Bang
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
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194
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Anxiety and depression scales of patients with congenital heart disease: Caution on 40 healthy controls as the reference population (reply). Int J Cardiol 2013; 168:4493. [DOI: 10.1016/j.ijcard.2013.06.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/30/2013] [Indexed: 11/22/2022]
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195
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Vanhalst J, Rassart J, Luyckx K, Goossens E, Apers S, Goossens L, Moons P. Trajectories of loneliness in adolescents with congenital heart disease: associations with depressive symptoms and perceived health. J Adolesc Health 2013; 53:342-9. [PMID: 23697788 DOI: 10.1016/j.jadohealth.2013.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/22/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Acquiring close peer relationships is an important developmental task in adolescence. This task may be particularly demanding for adolescents with congenital heart disease (CHD), who face disease-specific challenges putting them at risk for social isolation and loneliness. This study compared cross-sectional levels of loneliness in adolescents with and without CHD; examined the longitudinal course of loneliness and identified different developmental trajectory classes in adolescents with CHD; and investigated to what extent these trajectory classes are accompanied by differences in depressive symptoms and perceived health. METHODS A total of 429 adolescents with simple to complex CHD participated in the present longitudinal study consisting of three measurement waves with 9-month intervals (M(age) = 15.75 years at T1; 53.4% boys). The control sample at time 1 (T1) consisted of 403 adolescents who were matched in terms of age and sex. RESULTS Patients and controls did not differ in loneliness levels at T1. In adolescents with CHD, latent class growth analysis identified five trajectory classes (i.e., chronically high, high decreasing, moderate stable, low increasing, and stable low), which were meaningfully distinguished on depressive symptoms and several domains of perceived health. In general, adolescents in the chronically high loneliness trajectory reported the most depressive symptoms and the poorest perceived health, whereas adolescents in the low stable trajectory reported the opposite pattern. CONCLUSIONS Findings demonstrate that chronic feelings of loneliness are associated with worsened perceived health in adolescents with CHD. Intervention programs targeting patients' adjustment should be sensitive to the presence of such feelings.
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Affiliation(s)
- Janne Vanhalst
- School Psychology and Child and Adolescent Development, KU Leuven, Leuven, Belgium.
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196
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Schoormans D, Sprangers MAG, Budts W, Mulder BJM, Apers S, Moons P. Erratum to: Perceived health is partially associated with the symptomatological profile in patients with benign and severe conditions: the case of congenital heart disease. Qual Life Res 2013. [DOI: 10.1007/s11136-012-0281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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197
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Fragata J. Shall we treat congenital heart lesions, their suffering patients or also their families, and surrounding societal ambience? Transl Pediatr 2013; 2:87-9. [PMID: 26835298 PMCID: PMC4728934 DOI: 10.3978/j.issn.2224-4336.2013.07.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Results with the treatment of congenital heart defects (CHD) have improved markedly. However these patients, in their teens and adulthood ages, suffer from psychological dysfunctions of different natures, even psychiatric diseases, that must by thought and be properly managed. Not only these dysfunctions are related to clinical history profiles, but they are clearly related to social support, with impacts on the way quality of life (QOL) is perceived. This new vision creates a window of opportunities to act, now, on the aspect of their social modelling and psychological support, to improve QOL and psychological adaptation for these patients, already living longer, in order to make them living better.
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Affiliation(s)
- José Fragata
- Department Cardiothoracic and Congenital Heart Surgery, Hospital de Santa Marta, Nova Medical School, Lisbon, Portugal
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198
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Areias MEG, Pinto CI, Vieira PF, Teixeira F, Coelho R, Freitas I, Matos S, Castro M, Sarmento S, Viana V, Quintas J, Areias JC. Long term psychosocial outcomes of congenital heart disease (CHD) in adolescents and young adults. Transl Pediatr 2013; 2:90-8. [PMID: 26835299 PMCID: PMC4728933 DOI: 10.3978/j.issn.2224-4336.2013.06.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is a chronic illness with a high frequency in the worldwide population, and is normally diagnosed at birth or in uterus. Because of better conditions in diagnosis and early medical and surgical treatment, patients have survival rates of 90% and go further and further in life, facing different challenges in life cycle. In this study, we tested the effects of different demographic, clinical and psychosocial variables on the perception of quality of life (QOL), on psychosocial adjustment (PSA) and psychiatric morbidity (PM) of adolescents and young adults with CHD. OBJECTIVES We aimed to evaluate QOL, PM and PSA of adolescents and young adults with CHD and to determine which variables (demographic, clinical, and psychosocial) play a role in buffering stress and promoting resilience and which ones have a detrimental effect. METHODS The study enrolled 150 CHD patients (87 males and 63 females), 12 to 26 years (M: 17.45±3.373 years). The participants were interviewed regarding social support, family educational style, self-image, demographic information and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed self-reports questionnaires for assessment of QOL (WHOQOL-BREF) and PSA (YSR/ASR). RESULTS We found an 18.7% lifetime prevalence of psychopathology in our participants (25.4% in females and 13.8% in males). 57.1% had retentions in school (M: 1.53±0.804 year). The perception of QOL of CHD patients is better compared to the Portuguese population in the Social Relationships, Environmental, Physical and General Dimensions. However, it is worse in complex forms of CHD, in cyanotic patients, in moderate-to-severe residual lesions, in patients submitted to surgery and in patients with physical limitations. All of these variables, except presence of cyanosis, are also associated to a worse PSA. Social Support is very important in improving QOL of patients in all dimensions as well as academic performance. CONCLUSIONS Female patients and patients with poor academic performance and poor social support refer worse PSA and QOL.
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Affiliation(s)
- Maria Emília Guimarães Areias
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Catarina I Pinto
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Patrícia F Vieira
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Flávio Teixeira
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Rosália Coelho
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Isabela Freitas
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Samantha Matos
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Marta Castro
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Sofia Sarmento
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Victor Viana
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - Jorge Quintas
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
| | - José C Areias
- 1 Department of Psychology, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal ; 2 CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Universidade de Coimbra, Coimbra, Portugal ; 3 UNIPSA-CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal ; 4 Department of Paediatrics (Cardiology), Hospital São João, Porto Medical School, University of Porto, Portugal ; 5 Faculty of Nutrition, University of Porto, Portugal ; 6 Faculty of Law, University of Porto, Portugal ; 7 Unidade de Investigação Cardiovascular, University of Porto, Portugal
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Key issues of daily life in adults with congenital heart disease. Arch Cardiovasc Dis 2013; 106:404-12. [DOI: 10.1016/j.acvd.2013.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/07/2013] [Accepted: 02/14/2013] [Indexed: 12/31/2022]
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Cohen SB, Ginde S, Bartz PJ, Earing MG. Extracardiac complications in adults with congenital heart disease. CONGENIT HEART DIS 2013; 8:370-80. [PMID: 23663434 DOI: 10.1111/chd.12080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/27/2022]
Abstract
With the increasing number of adults living with repaired, or unrepaired, congenital heart disease, there is a growing incidence of extracardiac comorbidities. These comorbidities can affect various organ systems in complex ways, and may have a significant impact on a patient's quality of life and survival. Many of these potential complications may go undiagnosed until there is already a significant bearing on the patient's life. Therefore, it is important for physicians who care for the adult congenital patient to be mindful of these potential extracardiac complications, and actively assess for these complications in their adult congenital practice. Continued research to identify modifiable risk factors is needed so that both preventative and therapeutic management options for these extracardiac complications may be developed.
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Affiliation(s)
- Scott B Cohen
- The Wisconsin Adult Congenital Heart Disease Program (WAtCH), Medical College of Wisconsin, Milwaukee, Wis, USA
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