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Chowdhury D, Elliott PA, Asaki SY, Amdani S, Nguyen QT, Ronai C, Tierney S, Levy VY, Puri K, Altman CA, Johnson JN, Glickstein JS. Addressing Disparities in Pediatric Congenital Heart Disease: A Call for Equitable Health Care. J Am Heart Assoc 2024:e032415. [PMID: 38934870 DOI: 10.1161/jaha.123.032415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
While significant progress has been made in reducing disparities within the US health care system, notable gaps remain. This article explores existing disparities within pediatric congenital heart disease care. Congenital heart disease, the most common birth defect and a leading cause of infant death, has garnered substantial attention, revealing certain disparities within the US health care system. Factors such as race, ethnicity, insurance coverage, socioeconomic status, and geographic location are all commonalities that significantly affect health disparities in pediatric congenital heart disease. This comprehensive review sheds light on disparities from diverse perspectives in pediatric care, demonstrates the inequities and inequalities leading to these disparities, presents effective solutions, and issues a call to action for providers, institutions, and the health care system. Recognizing and addressing these disparities is imperative for ensuring equitable care and enhancing the long-term well-being of children affected by congenital heart disease. Implementing robust, evidence-based frameworks that promote responsible and safe interventions is fundamental to enduring change.
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Affiliation(s)
- Devyani Chowdhury
- Cardiology Care for Children Lancaster PA USA
- Nemours Cardiac Center Wilmington DE USA
| | | | - S Yukiko Asaki
- Department of Pediatric Cardiology University of Utah, and Primary Children's Hospital Salt Lake UT USA
| | - Shahnawaz Amdani
- Division of Cardiology & Cardiovascular Medicine, Children's Institute Department of Heart Vascular & Thoracic Cleveland OH USA
| | - Quang-Tuyen Nguyen
- Division of General Pediatrics, Department of Pediatrics Primary Children's Hospital, University of Utah Salt Lake City UT USA
| | - Christina Ronai
- Department of Pediatrics, Division of Pediatric Cardiology Oregon Health and Sciences University Portland OR USA
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics Harvard Medical School Boston MA USA
| | - Seda Tierney
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital Stanford University Medical Center Palo Alto CA USA
| | - Victor Y Levy
- Division of Pediatric Cardiology and Neonatology Logan Health Children's Hospital Kalispell MT USA
| | - Kriti Puri
- Section of Pediatric Cardiology, Department of Pediatrics Baylor College of Medicine Houston TX USA
| | | | - Jonathan N Johnson
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology Mayo Clinic Rochester MN USA
| | - Julie S Glickstein
- Division of Cardiology, Department of Pediatrics Columbia University Irving Medical Center New York NY USA
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Amdani S, Marino BS, Boyle G, Cassedy A, Lorts A, Morales D, Joong A, Burstein D, Bansal N, Sutcliffe DL. Impact of center volume on outcomes after ventricular assist device implantation in pediatric patients: An analysis of the STS-Pedimacs database. J Heart Lung Transplant 2024; 43:787-796. [PMID: 38199514 DOI: 10.1016/j.healun.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/01/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To date, no pediatric studies have highlighted the impact of center's ventricular assist device (VAD) volumes on post implant outcomes. METHODS Children (age <19) enrolled in Pedimacs undergoing initial left ventricular assist device implantation from 2012 to 2020 were included. Center volume was analyzed as a continuous and categorical variable. For categorical analysis, center volumes were divided as: low volume (1-15 implants), medium volume (15-30 implants), and high volume (>30 implants) during our study period. Patient characteristics and outcomes were compared by center's VAD volumes. RESULTS Of 44 centers, 16 (36.4%) were low, 11 (25%) were medium, and 17 (38.6%) were high-volume centers. Children at high-volume centers were least likely intubated, sedated, or paralyzed, and most likely ambulating preimplant (p < 0.05 for all). Center's VAD volumes were not a significant risk factor for mortality post implant when treated as a continuous or a categorical variable (p > 0.05). Compared to low volume, children at high-volume centers had fewer early neurological events. Compared to medium volume, those at high-volume centers had fewer late bleeding events (p < 0.05 for all). There were no significant differences in survival after an adverse event by hospital volumes (p > 0.05). CONCLUSIONS Although hospital volume does not affect post-VAD implant mortality, pediatric centers with higher VAD volumes have fewer patients intubated, sedated, paralyzed pre implant, and have lower adverse events. Failure to rescue was not significantly different between low, medium, and high-volume VAD centers.
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Affiliation(s)
- Shahnawaz Amdani
- Division of Pediatric Cardiology, Department of Heart, Vascular & Thoracic, Children's Institute, Cleveland Clinic Children's, Cleveland, Ohio.
| | - Bradley S Marino
- Division of Pediatric Cardiology, Department of Heart, Vascular & Thoracic, Children's Institute, Cleveland Clinic Children's, Cleveland, Ohio
| | - Gerard Boyle
- Division of Pediatric Cardiology, Department of Heart, Vascular & Thoracic, Children's Institute, Cleveland Clinic Children's, Cleveland, Ohio
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Angela Lorts
- Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - David Morales
- Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Anna Joong
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Danielle Burstein
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Neha Bansal
- Division of Pediatric Cardiology, Mount Sinai School of Medicine, New York, New York
| | - David L Sutcliffe
- Division of Pediatric Cardiology, Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
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Schumacher KR, Vitale C. It Is Shocking How Little We Have Talked About Cardiogenic Shock in Pediatrics. J Am Coll Cardiol 2024; 83:609-610. [PMID: 38296405 DOI: 10.1016/j.jacc.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Kurt R Schumacher
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
| | - Carolyn Vitale
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/DoctorVitale
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Amdani S, Auerbach SR, Bansal N, Chen S, Conway J, Silva JPDA, Deshpande SR, Hoover J, Lin KY, Miyamoto SD, Puri K, Price J, Spinner J, White R, Rossano JW, Bearl DW, Cousino MK, Catlin P, Hidalgo NC, Godown J, Kantor P, Masarone D, Peng DM, Rea KE, Schumacher K, Shaddy R, Shea E, Tapia HV, Valikodath N, Zafar F, Hsu D. Research Gaps in Pediatric Heart Failure: Defining the Gaps and Then Closing Them Over the Next Decade. J Card Fail 2024; 30:64-77. [PMID: 38065308 DOI: 10.1016/j.cardfail.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 01/13/2024]
Abstract
Given the numerous opportunities and the wide knowledge gaps in pediatric heart failure, an international group of pediatric heart failure experts with diverse backgrounds were invited and tasked with identifying research gaps in each pediatric heart failure domain that scientists and funding agencies need to focus on over the next decade.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio.
| | - Scott R Auerbach
- Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Neha Bansal
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine, New York, New York
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Conway
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Julie Pires DA Silva
- Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Jessica Hoover
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Kimberly Y Lin
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shelley D Miyamoto
- Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kriti Puri
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Jack Price
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Joseph Spinner
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Rachel White
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph W Rossano
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David W Bearl
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Melissa K Cousino
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Perry Catlin
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Nicolas Corral Hidalgo
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Justin Godown
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Paul Kantor
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - David M Peng
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Kelly E Rea
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Kurt Schumacher
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Robert Shaddy
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Erin Shea
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Henry Valora Tapia
- Division of Pediatric Cardiology, University of Utah. Salt Lake City, Utah
| | - Nishma Valikodath
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Daphne Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Amdani S, Lopez R, Schold JD, Tang WHW. 30- and 60-Day Readmission Rates for Children With Heart Failure in the United States. JACC. HEART FAILURE 2024; 12:83-96. [PMID: 37943220 DOI: 10.1016/j.jchf.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Studies on readmission for pediatric heart failure (HF) patients is sparse. OBJECTIVES This study evaluated 30- and 60-day readmission rates in pediatric HF patients from 2010 to 2019. METHODS The authors used data from the Nationwide Readmission Database to evaluate trends in 30- and 60-day hospital readmissions among pediatric patients with HF and compare them with adults with HF. Readmissions were also stratified by sex, diagnosis, neighborhood income, and hospital volume. RESULTS There were 84,731 hospital admissions for HF. Compared with children without HF, those with HF were older, had Medicare/Medicaid insurance, and resided in micropolitan areas and low-income neighborhoods. The 30- (19.5% vs 3.1%) and 60-day (27.5% vs 4.3%) all-cause readmission rates were higher for children with HF compared with those without HF. Compared with children without HF, lengths of stay, deaths, and costs related to their readmission were higher for children readmitted with HF (P < 0.05 for all). There was no significant decline in pediatric HF-related 30- or 60- day readmissions during the study period overall, or for those with congenital heart disease (P > 0.05), unlike adult HF readmissions (P < 0.01). Infants were at highest risk, and readmission rates for teenagers are rising. CONCLUSIONS The 30- and 60-day readmission rates for pediatric patients with HF in the current era is high (∼20% and 30%, respectively). Unlike adult HF, pediatric HF readmission rates have not declined. Pediatric HF patients readmitted to the hospital have higher death rates and greater resource utilization than patients without HF. National measures to decrease readmissions for pediatric patients with HF is warranted.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
| | - Rocio Lopez
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Zhang A, Zheng X, Shen Q, Zhang Q, Leng H. Family management experience of parents of children with chronic heart failure: A qualitative study. J Pediatr Nurs 2023; 73:e36-e42. [PMID: 37481387 DOI: 10.1016/j.pedn.2023.07.006] [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: 03/30/2023] [Revised: 07/09/2023] [Accepted: 07/09/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To explore the experience of family management among parents of children with chronic heart failure. DESIGN AND METHODS Qualitative descriptive phenomenology was used as the research design. The sample included 16 parents. For data collection, semi-structured interviews were conducted. Colaizzi's seven-step analysis method was used for data analysis. Themes were encoded and created with Nvivo 12.0 Plus software. RESULTS Three themes and ten sub-themes were identified: (1) weakened family socialization (diminished parental role in social education and insufficient socialization of children), (2) experience of five psychological stages (resistance, self-blame, worry, exhaustion, acceptance), and (3) family management dilemmas (low social awareness of the disease, heavy economic burden, and limited coping style). CONCLUSION The experience of parents of children with chronic heart failure is complex. The children have low socialization and face public prejudice. Parents are stressed by social education, economics, and the five psychological stages they have experienced. Families face difficulties such as heavy economic burdens and limited coping styles. PRACTICE IMPLICATIONS To address these complexities, pediatric nursing staff should take steps to improve family management and, as a result, children's quality of life. Our study provides a resource for pediatric nursing staff when implementing family management interventions.
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Affiliation(s)
- Ai Zhang
- Department of Cardiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianlan Zheng
- Department of Nursing Children's Hospital of Chongqing Medical University, China.
| | - Qiao Shen
- Department of Nursing Children's Hospital of Chongqing Medical University, China
| | - Qin Zhang
- Department of Cardiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongyao Leng
- Department of Nursing Children's Hospital of Chongqing Medical University, China
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7
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Celik A, Ural D, Sahin A, Colluoglu IT, Kanik EA, Ata N, Arugaslan E, Demir E, Ayvali MO, Ulgu MM, Temizhan A, Cavusoglu Y, Acar RD, Nalbantgil S, Asarcikli LD, Murat S, Birinci S, Yilmaz MB. Trends in heart failure between 2016 and 2022 in Türkiye (TRends-HF): a nationwide retrospective cohort study of 85 million individuals across entire population of all ages. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100723. [PMID: 37953995 PMCID: PMC10636276 DOI: 10.1016/j.lanepe.2023.100723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 11/14/2023]
Abstract
Background Data on the burden of heart failure (HF) outside western countries are limited, but available data suggest it may present differently in other countries. The aim of this study was to examine the incidence, prevalence, and survival rates of HF in Türkiye, with a specific focus on how these rates vary according to age, sex, comorbidities, and socioeconomic status (SES). Methods We harnessed the extensive National Electronic Database of the Turkish Ministry of Health, covering Turkey's entire population from January 1, 2016, to December 31, 2022, to identify 2,722,151 cases of HF and their associated comorbidities using ICD-10 codes. Analyzing the primary endpoint of all-cause mortality, our study utilized anonymized data to examine patient demographics, comorbidities, socioeconomic status, and survival patterns, employing statistical techniques to delve into relationships and trends. The data were segmented by gender, socioeconomic status, and age, involving cross-tabulations and statistical metrics to explore connections, odds ratios, and survival rates. Findings The estimated prevalence of HF was 2.114% in Türkiye at the end of 2022, with an annual incidence ranging between 3.00 and 6.06 per 1000 person years. Females were older than males (69.8 ± 13.9 years vs. 66.8 ± 13.9 years, respectively). The most common comorbidities were congenital heart diseases and anemia under the age of 20, and hypertension and atherosclerotic cardiovascular disease in the adult population. Only 23.6% (643,159/2,722,151) of patients were treated with any triple guideline-directed medical therapy (GDMT) and 3.6% (96,751/2,722,151) of patients were on quadruple GDMT. The survival rates for patients with HF at 1, 5, and 7 years were 83.3% (95% CI: 83.2-83.3), 61.5% (95% CI: 61.4-61.6), and 57.7% (95% CI: 57.6-57.8) among females, and 82.1% (95% CI: 82.0-82.2), 58.2% (95% CI: 58.1-58.3), and 54.2% (95% CI: 54.0-54.3) among males. Despite a tendency for an increase from the highest to the lowest SES, the prevalence of HF and mortality were paradoxically lowest in the lowest SES region. Interpretation The prevalence, incidence, and survival rates of HF in Türkiye were comparable to western countries, despite the notable difference of HF onset occurring 8-10 years earlier in the Turkish population. Drug usage statistics indicate there is a need for effective strategies to improve treatment with GDMT. Funding None.
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Affiliation(s)
- Ahmet Celik
- Department of Cardiology, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Dilek Ural
- Department of Cardiology, Koç University, Faculty of Medicine, Istanbul, Türkiye
| | - Anil Sahin
- Department of Cardiology, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Türkiye
| | - Inci Tugce Colluoglu
- Department of Cardiology, Karabük University, Faculty of Medicine, Karabük, Türkiye
| | - Emine Arzu Kanik
- Department of Biostatistics and Medical Informatics, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Naim Ata
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Emre Arugaslan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Emre Demir
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Mustafa Okan Ayvali
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Mustafa Mahir Ulgu
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Ahmet Temizhan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Yuksel Cavusoglu
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Rezzan Deniz Acar
- Department of Cardiology, Health Science University, Faculty of Medicine, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Lale Dinc Asarcikli
- Department of Cardiology, Health Science University, Faculty of Medicine, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Selda Murat
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Suayip Birinci
- Deputy Minister of Health, Ministry of Health, Ankara, Türkiye
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Türkiye
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Cousino MK, Miller VA, Smith C, Lim HM, Yu S, Lowery R, Uzark K, Fredericks EM, Wolfe J, Blume ED, Schumacher KR. Medical and End-of-Life Decision-Making Preferences in Adolescents and Young Adults with Advanced Heart Disease and Their Parents. JAMA Netw Open 2023; 6:e2311957. [PMID: 37145598 PMCID: PMC10163392 DOI: 10.1001/jamanetworkopen.2023.11957] [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] [Indexed: 05/06/2023] Open
Abstract
Importance Despite high disease morbidity and mortality and complex treatment decisions, little is known about the medical and end-of-life decision-making preferences of adolescents and young adults (AYA) with advanced heart disease. AYA decision-making involvement is associated with important outcomes in other chronic illness groups. Objective To characterize decision-making preferences of AYAs with advanced heart disease and their parents and determine factors associated with these preferences. Design, Setting, and Participants Cross-sectional survey between July 2018 and April 2021 at a single-center heart failure/transplant service at a Midwestern US children's hospital. Participants were AYAs aged 12 to 24 years with heart failure, listed for heart transplantation, or posttransplant with life-limiting complications and a parent/caregiver. Data were analyzed from May 2021 to June 2022. Main Outcomes and Measures Single-item measure of medical decision-making preferences, MyCHATT, and Lyon Family-Centered Advance Care Planning Survey. Results Fifty-six of 63 eligible patients enrolled in the study (88.9%) with 53 AYA-parent dyads. Median (IQR) patient age was 17.8 (15.8-19.0) years; 34 (64.2%) patients were male, and 40 patients (75.5%) identified as White and 13 patients (24.5%) identified as members of a racial or ethnic minority group or multiracial. The greatest proportion of AYA participants (24 of 53 participants [45.3%]) indicated a preference for active, patient-led decision-making specific to heart disease management, while the greatest proportion of parents (18 of 51 participants [35.3%]) preferred they and physician(s) make shared medical decisions on behalf of their AYA, representing AYA-parent decision-making discordance (χ2 = 11.7; P = .01). Most AYA participants stated a preference to discuss adverse effects or risks of treatment (46 of 53 participants [86.8%]), procedural and/or surgical details (45 of 53 participants [84.9%]), impact of condition on daily activities (48 of 53 participants [90.6%]), and their prognosis (42 of 53 participants [79.2%]). More than half of AYAs preferred to be involved in end-of-life decisions if very ill (30 of 53 participants [56.6%]). Longer time since cardiac diagnosis (r = 0.32; P = .02) and worse functional status (mean [SD] 4.3 [1.4] in New York Heart Association class III or IV vs 2.8 [1.8] in New York Heart Association class I or II; t-value = 2.7; P = .01) were associated with a preference for more active, patient-led decision-making. Conclusions and Relevance In this survey study, most AYAs with advanced heart disease favored active roles in medical decision-making. Interventions and educational efforts targeting clinicians, AYAs with heart disease, and their caregivers are needed to ensure they are meeting the decision-making and communication preferences of this patient population with complex disease and treatment courses.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor
| | - Victoria A Miller
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia Smith
- Department of Pediatrics, Michigan Medicine, Ann Arbor
| | - Heang M Lim
- Department of Pediatrics, Michigan Medicine, Ann Arbor
| | - Sunkyung Yu
- Department of Pediatrics, Michigan Medicine, Ann Arbor
| | - Ray Lowery
- Department of Pediatrics, Michigan Medicine, Ann Arbor
| | - Karen Uzark
- Department of Pediatrics, Michigan Medicine, Ann Arbor
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor
| | | | - Joanne Wolfe
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth D Blume
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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Williams K, Khan A, Lee YS, Hare JM. Cell-based therapy to boost right ventricular function and cardiovascular performance in hypoplastic left heart syndrome: Current approaches and future directions. Semin Perinatol 2023; 47:151725. [PMID: 37031035 PMCID: PMC10193409 DOI: 10.1016/j.semperi.2023.151725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Congenital heart disease remains one of the most frequently diagnosed congenital diseases of the newborn, with hypoplastic left heart syndrome (HLHS) being considered one of the most severe. This univentricular defect was uniformly fatal until the introduction, 40 years ago, of a complex surgical palliation consisting of multiple staged procedures spanning the first 4 years of the child's life. While survival has improved substantially, particularly in experienced centers, ventricular failure requiring heart transplant and a number of associated morbidities remain ongoing clinical challenges for these patients. Cell-based therapies aimed at boosting ventricular performance are under clinical evaluation as a novel intervention to decrease morbidity associated with surgical palliation. In this review, we will examine the current burden of HLHS and current modalities for treatment, discuss various cells therapies as an intervention while delineating challenges and future directions for this therapy for HLHS and other congenital heart diseases.
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Affiliation(s)
- Kevin Williams
- Department of Pediatrics, University of Miami Miller School of Medicine. Miami FL, USA; Batchelor Children's Research Institute University of Miami Miller School of Medicine. Miami FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami FL, USA
| | - Yee-Shuan Lee
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami FL, USA; Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine. Miami FL, USA.
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10
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Preminger TJ. Telemedicine in pediatric cardiology: pros and cons. Curr Opin Pediatr 2022; 34:484-490. [PMID: 35983842 DOI: 10.1097/mop.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review recent uses of telemedicine in pediatric cardiology, highlighting merits, challenges, and future directions. RECENT FINDINGS The COVID-19 pandemic accelerated telemedicine use, which has had a positive impact with respect to providers, patients, and their caregivers. Recent data have demonstrated the feasibility and effectiveness of telemedicine through expediting needed care and reducing healthcare utilization, including unnecessary emergency department visits, transports, and hospitalizations. With increasing complexity of cardiac care, telecardiology allows for establishing a medical home, improving access, and continuity of care. Great potential also exists for telecardiology to permit more consistent preventive care, possibly resulting in improved health equity, reduced morbidity and mortality, and associated costs. Challenges to optimal implementation of telecardiology, which are all surmountable, include the currently unaccounted additional workload and administrative burden, licensing restrictions, disparities in access to care, insurance reimbursement, and potential fraud and abuse. SUMMARY Telecardiology allows for efficient, quality, effective, collaborative care and is foundational to creating innovative, high-value care models. Through integration with accelerating technology and in-person visits, a sustainable hybrid model of optimal care can be achieved. Addressing barriers to progress in telecardiology is critical.
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Affiliation(s)
- Tamar J Preminger
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Daly KP, Zuckerman WA. The Burden of Pediatric Heart Failure That Lies Just Under the Surface. J Am Coll Cardiol 2022; 79:1929-1931. [PMID: 35550690 DOI: 10.1016/j.jacc.2022.03.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin P Daly
- Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
| | - Warren A Zuckerman
- Department of Pediatrics, Columbia University College of Physician & Surgeons, New York, New York, USA
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