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Bredy C, Werner O, Huguet H, Guillaumont S, Auer A, Requirand A, Lavastre K, Abassi H, De La Villeon G, Vincenti M, Gavotto A, Vincent R, Pommier V, Dulac Y, Souletie N, Acar P, Karsenty C, Guitarte A, Berge M, Marguin G, Masseron MP, Pages L, Bourrel G, Engberink AO, Million E, Huby AC, Leobon B, Picot MC, Amedro P. Efficacy of a Transition Program in Adolescents and Young Adults With Congenital Heart Disease: The TRANSITION-CHD Randomized Controlled Trial. J Adolesc Health 2024; 75:358-367. [PMID: 38864791 DOI: 10.1016/j.jadohealth.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/09/2024] [Accepted: 04/15/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Currently, nearly 90% of patients with congenital heart disease (CHD) reach adulthood in relatively good health. Structured transition programs have emerged to support adolescents and young adults in transitioning to adult care structures, improve their autonomy, and limit healthcare ruptures. The TRANSITION-CHD randomized controlled trial aimed to assess the impact of a transition program on health-related quality of life (HRQoL) in adolescents and young adults with CHD. METHODS From January 2017 to February 2020, 200 subjects with a CHD, aged 13-25 years, were enrolled in a prospective, controlled, multicenter study and randomized in two balanced groups (transition program vs. standard of care). The primary outcome was the change in PedsQL self-reported HRQoL score between baseline and 12-month follow-up, using an intention-to-treat analysis. The secondary outcomes were the change in disease knowledge, physical health (cardiopulmonary fitness, physical activity), and mental health (anxiety, depression). RESULTS The change in HRQoL differed significantly between the transition group and the control group (mean difference = 3.03, 95% confidence interval (CI) = [0.08; 5.98]; p = .044; effect size = 0.30), in favor of the intervention group. A significant increase was also observed in the self-reported psychosocial HRQoL (mean difference = 3.33, 95% CI = [0.01; 6.64]; p = .049; effect size = 0.29), in the proxy-reported physical HRQoL (mean difference = 9.18, 95% CI = [1.86; 16.51]; p = .015; effect size = 0.53), and in disease knowledge (mean difference = 3.13, 95% CI = [1.54; 4.72]; p < .001; effect size = 0.64). DISCUSSION The TRANSITION-CHD program improved HRQoL and disease knowledge in adolescents and young adults with CHD, supporting the generalization and systematization of similar preventive interventions in pediatric and congenital cardiology.
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Affiliation(s)
- Charlene Bredy
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Oscar Werner
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France; Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Annie Auer
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France; PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Remi Vincent
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Victor Pommier
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Yves Dulac
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Nathalie Souletie
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Philippe Acar
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Clement Karsenty
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Aitor Guitarte
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Marie Berge
- Patient Advocacy Organisation « Association Petit Cœur de Beurre », La Garenne Colombes, France
| | - Gaelle Marguin
- Patient Advocacy Organisation « Association Petit Cœur de Beurre », La Garenne Colombes, France
| | - Marie-Paule Masseron
- Patient Advocacy Organisation « Association Nationale des Cardiaques Congenitaux », Paris, France
| | - Laurence Pages
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Gerard Bourrel
- Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, University of Montpellier, Montpellier, France
| | - Agnes Oude Engberink
- Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, University of Montpellier, Montpellier, France
| | - Elodie Million
- Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, University of Montpellier, Montpellier, France
| | - Anne-Cecile Huby
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Bertrand Leobon
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France; Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France.
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Matthews S, Cook S, Clayton T, Murray S, Wynne R, Sanders J. Factors affecting women's participation in cardiovascular research: a scoping review. Eur J Cardiovasc Nurs 2024; 23:107-114. [PMID: 37201192 DOI: 10.1093/eurjcn/zvad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
AIMS Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies. METHODS AND RESULTS Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate.From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction, and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, childcare availability, and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention. CONCLUSION This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women's participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women's participation in cardiovascular research. REGISTRATION The protocol was published on the public Open Science Framework platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/.
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Affiliation(s)
- Stacey Matthews
- National Heart Foundation of Australia, 850 Collins Street, Melbourne VIC 3000, Australia
- Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia
| | - Samantha Cook
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Tim Clayton
- Department of Medical Statistics, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sarah Murray
- Society of Cardiothoracic Surgery of Great Britain and Ireland, London WC2A 3PE, UK
| | - Rochelle Wynne
- Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong, NSW 2522, Australia
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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John AS, Jackson JL, Moons P, Uzark K, Mackie AS, Timmins S, Lopez KN, Kovacs AH, Gurvitz M. Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025278. [PMID: 35297271 PMCID: PMC9075425 DOI: 10.1161/jaha.122.025278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.
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Adedinsewo DA, Pollak AW, Phillips SD, Smith TL, Svatikova A, Hayes SN, Mulvagh SL, Norris C, Roger VL, Noseworthy PA, Yao X, Carter RE. Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools. Circ Res 2022; 130:673-690. [PMID: 35175849 PMCID: PMC8889564 DOI: 10.1161/circresaha.121.319876] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.
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Affiliation(s)
- Demilade A. Adedinsewo
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Amy W. Pollak
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Sabrina D. Phillips
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Taryn L. Smith
- Division of General Internal Medicine (T.L.S.), Mayo Clinic, Jacksonville, FL
| | - Anna Svatikova
- Department of Cardiovascular Diseases (A.S.), Mayo Clinic, Phoenix, AZ
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada (S.L.M.)
| | - Colleen Norris
- Cardiovascular Health and Stroke Strategic Clinical Network, Edmonton, Canada (C.N.)
| | - Veronique L. Roger
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences (V.L.R.), Mayo Clinic, Rochester, MN
- Epidemiology and Community Health Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.R.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences (R.E.C.), Mayo Clinic, Jacksonville, FL
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Oudkerk Pool MD, Hooglugt JLQ, Schijven MP, Mulder BJM, Bouma BJ, de Winter RJ, Pinto Y, Winter MM. Review of Digitalized Patient Education in Cardiology: A Future Ahead? Cardiology 2021; 146:263-271. [PMID: 33550295 DOI: 10.1159/000512778] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/11/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION An increased focus on shared decision-making and patient empowerment in cardiology and on patient outcomes such as quality of life (QoL), depression, and anxiety underline the importance of high-quality patient education. Studies focusing on digital means of patient education performed in other disciplines of medicine demonstrated its positive effect in these areas. Therefore, a review of the current literature was performed to (i) evaluate the status of innovative, digitalized means of patient education in cardiology and (ii) assess the impact of digital patient education on outcome parameters (i.e., patient knowledge (or health literacy), QoL, depression, anxiety, and patient satisfaction). METHOD A review of the current literature was performed to evaluate the effect of digitalized patient education for any purpose in the field of cardiology. Medline and EMBASE were searched for articles reporting any digital educational platform used for patient education up to May 2020. The articles were compared on their effect on patient knowledge or health literacy, QoL, depression or anxiety, and patient satisfaction. RESULTS The initial search yielded 279 articles, 34 of which were retained after applying in, and exclusion criteria. After full-text analysis, the total number of articles remaining was 16. Of these, 6 articles discussed the use of smartphone or tablet applications as a means of patient education, whereas 3 reviewed web-based content, and 7 evaluated the use of video (2 three-dimensional videos, from which one on a virtual reality headset). CONCLUSION This review demonstrates that digital patient education increases patient knowledge. Overall, digital education increases QoL and lowers feelings of depression and anxiety. The majority of patients express satisfaction with digital platforms. It remains important that developers of digital patient education platforms remain focused on clear, structured, and comprehensible information presentation.
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Affiliation(s)
- Marinka D Oudkerk Pool
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands, .,Netherlands Heart Institute, Utrecht, The Netherlands,
| | - Jean-Luc Q Hooglugt
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yigal Pinto
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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A transition clinic intervention to improve follow-up rates in adolescents and young adults with congenital heart disease. Cardiol Young 2020; 30:633-640. [PMID: 32279695 PMCID: PMC7778829 DOI: 10.1017/s1047951120000682] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with congenital heart disease (CHD) require lifelong cardiology follow-up. Many experience gaps in care around the age of transition to adult-oriented care with associated comorbidity. We describe the impact of a clinic-based intervention on follow-up rates in this high-risk population. METHODS Patients ≥11 years seen in a paediatric outpatient CHD Transition Clinic completed self-assessment questionnaires, underwent focused teaching, and were followed on a clinic registry with assessment of care continuation. The cohort "lost to follow-up" rate, defined as absence from care at least 6 months beyond the recommended timeframe, was compared with a control group. Secondary outcomes included questionnaire scores and adult cardiology referral trends. RESULTS Over 26 months, 53 participants completed an initial Transition Clinic visit; 43% (23/53) underwent a second visit. Median participant age was 18.0 years (interquartile range 16.0, 22.0). The cohort's "lost to follow-up" rate was 7.3%, which was significantly lower than the control rate (25.9%, p < 0.01). Multivariable regression analyses demonstrated clinic participation as the only factor independently associated with follow-up rates (p = 0.048). Transition readiness was associated with older age (p = 0.01) but not sex, univentricular heart, interventional history, or surgical complexity. One-third of adult participants transferred to adult care. CONCLUSIONS A CHD Transition Clinic intervention can improve follow-up rates in adolescents and young adults. Age is an important factor in transition readiness, and retention of adults in paediatric care appears multi-factorial. We postulate that serial assessments of self-management, focused education, and registry utilisation may improve patient outcomes by reducing lapses in care.
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Saha P, Potiny P, Rigdon J, Morello M, Tcheandjieu C, Romfh A, Fernandes SM, McElhinney DB, Bernstein D, Lui GK, Shaw GM, Ingelsson E, Priest JR. Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease. Circulation 2020; 139:1889-1899. [PMID: 30813762 DOI: 10.1161/circulationaha.118.037064] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk of adverse cardiovascular events associated with lower-complexity ACHD that is unmeasured by conventional risk factors. METHODS A multitiered classification algorithm was used to select individuals with lower-complexity ACHD and individuals without ACHD for comparison among >500 000 British adults in the UK Biobank. ACHD diagnoses were subclassified as isolated aortic valve and noncomplex defects. Time-to-event analyses were conducted for the primary end points of fatal or nonfatal acute coronary syndrome, ischemic stroke, heart failure, and atrial fibrillation and a secondary combined end point for major adverse cardiovascular events. Maximum follow-up time for the study period was 22 years with retrospectively and prospectively collected data from the UK Biobank. RESULTS We identified 2006 individuals with lower-complexity ACHD and 497 983 unexposed individuals in the UK Biobank (median age at enrollment, 58 [interquartile range, 51-63] years). Of the ACHD-exposed group, 59% were male, 51% were current or former smokers, 30% were obese, and 69%, 41%, and 7% were diagnosed or treated for hypertension, hyperlipidemia, and diabetes mellitus, respectively. After adjustment for 12 measured cardiovascular risk factors, ACHD remained strongly associated with the primary end points, with hazard ratios ranging from 2.0 (95% CI, 1.5-2.8; P<0.001) for acute coronary syndrome to 13.0 (95% CI, 9.4-18.1; P<0.001) for heart failure. ACHD-exposed individuals with ≤2 cardiovascular risk factors had a 29% age-adjusted incidence rate of major adverse cardiovascular events, in contrast to 13% in individuals without ACHD with ≥5 risk factors. CONCLUSIONS Individuals with lower-complexity ACHD had a higher burden of adverse cardiovascular events relative to the general population that was unaccounted for by conventional cardiovascular risk factors. These findings highlight the need for closer surveillance of patients with mild to moderate ACHD and further investigation into management and mechanisms of cardiovascular risk unique to this growing population of high-risk adults.
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Affiliation(s)
- Priyanka Saha
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Harvard Medical School, Boston, MA (P.S.)
| | - Praneetha Potiny
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA
| | - Joseph Rigdon
- Quantitative Sciences Unit (J.R.), Stanford University School of Medicine, CA
| | - Melissa Morello
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Catherine Tcheandjieu
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Anitra Romfh
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Susan M Fernandes
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Doff B McElhinney
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Cardiothoracic Surgery (D.B.M.), Stanford University School of Medicine, CA
| | - Daniel Bernstein
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA
| | - George K Lui
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Gary M Shaw
- Department of Pediatrics (G.M.S.), Stanford University School of Medicine, CA
| | - Erik Ingelsson
- Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.)
| | - James R Priest
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.).,Chan-Zuckerberg BioHub, San Francisco, CA (J.R.P.)
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Uzark K, Afton K, Yu S, Lowery R, Smith C, Norris MD. Transition Readiness in Adolescents and Young Adults with Heart Disease: Can We Improve Quality of Life? J Pediatr 2019; 212:73-78. [PMID: 31182220 DOI: 10.1016/j.jpeds.2019.04.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We previously reported common knowledge deficits and lack of transition readiness in 13- 25-year-olds with congenital or acquired heart disease. The aims of this study were to re-evaluate transition readiness in this cohort at follow-up and to examine the relationship between changes in transition readiness and quality of life (QOL). STUDY DESIGN In this prospective cohort study, patients completed the Transition Readiness Assessment and the Pediatric Quality of Life Inventory using an e-tablet, web-based format at a routine follow-up visit. Changes from initial to follow-up scores were evaluated. RESULTS Sixty-five percent of patients (106 of 164) completed follow-up assessments at a median age of 18.7 years (IQR, 16.5-21.2 years) at a median follow-up of 1 year. The average perceived knowledge deficit score (percent of items with no knowledge) at follow-up was 18.0 ± 15.2%, which decreased from 24.7 ± 16.5% (P < .0001). On a 100-point scale, the mean score for self-efficacy increased from 71.4 ± 17.0 to 76.7 ± 18.2 (P = .0004) and for self-management increased from 47.9 ± 18.4 to 52.0 ± 20.7 (P = .004). Although physical QOL did not change, the mean psychosocial QOL score increased significantly (P = .02). A decrease in the knowledge deficit score at follow-up was significantly associated with an increased psychosocial QOL score (P = .03). An increase in the self-efficacy score was associated with an increase in psychosocial QOL score (P = .04), especially social QOL (P = .02). CONCLUSIONS Although deficits in knowledge and self-management skills persist, transition readiness assessment and recognition of deficits can improve transition readiness with improved psychosocial QOL.
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Affiliation(s)
- Karen Uzark
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI; Department of Cardiac Surgery, University of Michigan Mott Children's Hospital, Ann Arbor, MI.
| | - Katherine Afton
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Sunkyung Yu
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Ray Lowery
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Cynthia Smith
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Mark D Norris
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
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Ephrem G, Alshawabkeh L. Contemporary ACHD training and the reality of the field in the United States. Int J Cardiol 2019; 277:85-89. [DOI: 10.1016/j.ijcard.2018.08.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/24/2018] [Indexed: 11/26/2022]
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10
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Bauer UM, Helm PC, Diller GP, Asfour B, Schlensak C, Schmitt K, Ewert P, Tutarel O. Are adults with congenital heart disease informed about their risk for infective endocarditis and treated in accordance to current guidelines? Int J Cardiol 2017; 245:105-108. [DOI: 10.1016/j.ijcard.2017.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/06/2017] [Accepted: 07/12/2017] [Indexed: 12/17/2022]
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11
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Chen CW, Ho CL, Su WJ, Wang JK, Chung HT, Lee PC, Lu CW, Hwang BT. Initial validation of a healthcare needs scale for young people with congenital heart disease. J Adv Nurs 2017; 74:223-231. [DOI: 10.1111/jan.13390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Chi-Wen Chen
- School of Nursing; National Yang-Ming University; Taipei Taiwan
| | - Ciao-Lin Ho
- School of Nursing; National Yang-Ming University; Taipei Taiwan
| | - Wen-Jen Su
- Department of Pediatrics; Chang Gung Children's Hospital; Taoyuan Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics; National Taiwan University Hospital; Taipei Taiwan
| | - Hung-Tao Chung
- Department of Pediatrics; Chang Gung Children's Hospital; Taoyuan Taiwan
| | - Pi-Chang Lee
- Department of Pediatrics; Taipei Veterans General Hospital; Taipei Taiwan
| | - Chun-Wei Lu
- Adult Congenital Heart Center & Department of Pediatrics; National Taiwan University Hospital; Taipei Taiwan
| | - Be-Tau Hwang
- Department of Pediatrics and Cardiovascular Center; Tungs’ Taichung MetroHarbor Hospital; Taichung Taiwan
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12
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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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13
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Dolgner SJ, Deen JF, Stout KK. Transitioning the Pediatric Patient to the Adult Congenital Heart Disease Service. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Abstract
Advanced surgical repair procedures have resulted in the increased survival rate to adulthood of patients with CHD. The resulting new chronic conditions population is greater than one million in the United States of America and >1.2 million in Europe. This review describes the risks and effects of infective endocarditis - a systemic infectious process with high morbidity and mortality - on this population and examines the evidence to determine whether greater patient education on recognition of symptoms and preventative measures is warranted. The literature search included the terms "infective endocarditis" and "adult congenital heart disease". Search refinement, the addition of articles cited by included articles, as well as addition of supporting articles, resulted in utilisation of 24 articles. Infective endocarditis, defined by the modified Duke Criteria, occurs at a significantly higher rate in the CHD population due to congenitally or surgically altered cardiac anatomies and placement of prosthetic valves. This literature review returned no studies in the past five years assessing knowledge of the definition, recognition of symptoms, and preventative measures of infective endocarditis in the adult CHD population. Existing data are more than 15 years old and show significant knowledge deficits. Studies have consistently shown the need for improved CHD patient knowledge with regard to infective endocarditis, and there is no recent evidence that these knowledge deficits have decreased. It is important to address and decrease knowledge deficits in order to improve patient outcomes and decrease healthcare utilisation and costs.
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McCabe N, Dunbar SB, Butler J, Higgins M, Book W, Reilly C. Antecedents of self-care in adults with congenital heart defects. Int J Cardiol 2015; 201:610-5. [PMID: 26340127 PMCID: PMC4604062 DOI: 10.1016/j.ijcard.2015.08.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/13/2015] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adults with congenital heart defects (ACHD) face long-term complications related to prior surgery, abnormal anatomy, and acquired cardiovascular conditions. Although self-care is an important part of chronic illness management, few studies have explored self-care in the ACHD population. The purpose of this study is to describe self-care and its antecedents in the ACHD population. METHODS Persons with moderate or severe ACHD (N=132) were recruited from a single ACHD center. Self-care (health maintenance behaviors, monitoring and management of symptoms), and potential antecedents including sociodemographic and clinical characteristics, ACHD knowledge, behavioral characteristics (depressive symptoms and self-efficacy), and family-related factors (parental overprotection and perceived family support) were collected via self-report and chart review. Multiple regression was used to identify antecedents of self-care maintenance, monitoring, and management. RESULTS Only 44.7%, 27.3%, and 23.3% of participants performed adequate levels of self-care maintenance, monitoring and management, respectively. In multiple regression analysis, self-efficacy, education, gender, perceived family support, and comorbidities explained 25% of the variance in self-care maintenance (R(2)=.248, F(5, 123)=9.44, p<.001). Age, depressive symptoms, self-efficacy, and NYHA Class explained 23% of the variance in self-care monitoring (R(2)=.232, F(2, 124)=10.66, p<.001). Self-efficacy and NYHA Class explained 9% of the variance in self-care management (R(2)=.094, F(2, 80)=5.27, p=.007). CONCLUSIONS Low levels of self-care are common among persons with ACHD. Multiple factors, including modifiable factors of self-efficacy, depressive symptoms, and perceived family support, are associated with self-care and should be considered in designing future interventions to improve outcomes in the ACHD population.
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Affiliation(s)
- Nancy McCabe
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Javed Butler
- Cardiology Division, School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Wendy Book
- Cardiology Division, School of Medicine, Emory University, Atlanta, GA, United States
| | - Carolyn Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
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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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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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Update on the challenges facing the adult with congenital heart disease community: for both the patient and provider. Curr Opin Pediatr 2014; 26:521-6. [PMID: 25102108 DOI: 10.1097/mop.0000000000000134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The success in the management of congenital heart disease has resulted in a growing population now expected to reach adulthood. The declining mortality during childhood results in adults with decades of cardiovascular disease burden. The purpose of this review is to provide an update on some of the common issues encountered when caring for the adult with congenital heart disease through a review of recently published articles. RECENT FINDINGS This review focuses on addressing the lack of information, gaps in clinical care, single ventricle complications, and heart failure in the adults with congenital heart disease population. SUMMARY The advancing age of the congenital heart population comes with a substantial life cardiovascular risk. Despite this, they typically experience and report a good quality of life. Providing care to adults with congenital heart disease requires a comprehensive team to address the many complications that are known to arise. This comprehensive team should be available to all.
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19
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Mackie AS, Islam S, Magill-Evans J, Rankin KN, Robert C, Schuh M, Nicholas D, Vonder Muhll I, McCrindle BW, Yasui Y, Rempel GR. Healthcare transition for youth with heart disease: a clinical trial. Heart 2014; 100:1113-8. [DOI: 10.1136/heartjnl-2014-305748] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Swan L. Congenital heart disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2014; 28:495-506. [PMID: 24675221 DOI: 10.1016/j.bpobgyn.2014.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
The story of congenital heart disease is one of the major successes of medicine in the last 50 years. Heart conditions previously associated with early death are now successfully treated. Many of these women are now in their child-bearing years wishing to have children of their own. All of these women should be offered comprehensive pre-conception counselling by a dedicated multi-disciplinary team. Each woman will present a unique set of cardiac and obstetric challenges that require an individualised assessment of risk and a carefully documented care plan. In this chapter, I describe the most common forms of congenital heart disease and the specific issues that should be assessed before conception. I present a systematic approach to risk stratification and care planning. These lesions range from mild disease with little implications for pregnancy to those with a sizable risk of maternal mortality or complications. I will also discuss fetal risk factors.
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Affiliation(s)
- Lorna Swan
- Adult Congenital Heart Disease Unit, Royal Brompton Hospital, London SW3 6NP, UK.
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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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Kovacs AH, McCrindle BW. So hard to say goodbye: transition from paediatric to adult cardiology care. Nat Rev Cardiol 2013; 11:51-62. [DOI: 10.1038/nrcardio.2013.172] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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