1
|
Liu YS, Chung HT, Wang JK, Yang CY, Liu CY, Chen CW. How grit mediates depressive symptoms with life and job satisfaction in full-time employed adults with congenital heart disease. Appl Nurs Res 2024; 79:151845. [PMID: 39256014 DOI: 10.1016/j.apnr.2024.151845] [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: 07/07/2024] [Revised: 08/31/2024] [Accepted: 09/01/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Technological advancements have extended the lifespan of individuals with congenital heart disease (CHD), but physical and mental health issues can affect their life and job satisfaction. AIMS This study examined whether grit can protect full-time employed adults with CHD from depression by exploring its mediating role between depressive symptoms and life or job satisfaction. METHODS A cross-sectional design involved 181 adults with CHD assessed using the Patient Health Questionnaire, Grit-10, Satisfaction with Life Scale, and Basic Psychological Need Satisfaction at Work Scale. Data analysis was conducted with SPSS and Smart PLS software for partial least squares structural equation modeling, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS Indicated that depressive symptoms were negatively correlated with grit, life satisfaction, and job satisfaction, while grit was positively correlated with both satisfaction measures. Grit partially mediated the relationship between depressive symptoms and life/job satisfaction, accounting for 30.70 % and 29.11 % of the variance, respectively. CONCLUSIONS Grit significantly mitigates the negative impact of depressive symptoms on life and job satisfaction in full-time employed adults with CHD. Nurses should identify signs of depression in adults with CHD and evaluate their grit levels. Interventions to increase grit and reduce depressive symptoms could enhance life and job satisfaction.
Collapse
Affiliation(s)
- Yu-Shiu Liu
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
| | - Hung-Tao Chung
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatric Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Chiu-Yueh Yang
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
2
|
Roos-Hesselink JW, Pelosi C, Brida M, De Backer J, Ernst S, Budts W, Baumgartner H, Oechslin E, Tobler D, Kovacs AH, Di Salvo G, Kluin J, Gatzoulis MA, Diller GP. Surveillance of adults with congenital heart disease: Current guidelines and actual clinical practice. Int J Cardiol 2024; 407:132022. [PMID: 38636602 DOI: 10.1016/j.ijcard.2024.132022] [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: 01/26/2024] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND AIM Congenital heart disease (CHD) is the most common birth defect with prevalence of 0.8%. Thanks to tremendous progress in medical and surgical practice, nowadays, >90% of children survive into adulthood. Recently European Society of Cardiology (ESC), American College of Cardiology (ACC)/ American Heart Association (AHA) issued guidelines which offer diagnostic and therapeutic recommendations for the different defect categories. However, the type of technical exams and their frequency of follow-up may vary largely between clinicians and centres. We aimed to present an overview of available diagnostic modalities and describe current surveillance practices by cardiologists taking care of adults with CHD (ACHD). METHODS AND RESULTS A questionnaire was used to assess the frequency cardiologists treating ACHD for at least one year administrated the most common diagnostic tests for ACHD. The most frequently employed diagnostic modalities were ECG and echocardiography for both mild and moderate/severe CHD. Sixty-seven percent of respondents reported that they routinely address psychosocial well-being. CONCLUSION Differences exist between reported current clinical practice and published guidelines. This is particularly true for the care of patients with mild lesions. In addition, some differences exist between ESC and American guidelines, with more frequent surveillance suggested by the Americans.
Collapse
Affiliation(s)
- Jolien W Roos-Hesselink
- Department of Adult Congenital Cardiology, Erasmus Medical Center, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Margarita Brida
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Belgium
| | - Sabine Ernst
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Herestraat 49, Leuven B-3000, Belgium
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, University Health Network, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Giovanni Di Salvo
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; Paediatric Cardiology and CHD, University Hospital of Padua, Italy
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Aristotle University Medical School, Thessaloniki, Greece
| | - Gerhard P Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany; School of Cardiovascular Medicine & Sciences, Kings College, London WC2R 2LS, UK
| |
Collapse
|
3
|
Osteen K, Tucker CA, Meraz R. We Have to Really Decide: The Childbearing Decisions of Women With Congenital Heart Disease. J Cardiovasc Nurs 2024; 39:325-334. [PMID: 37747321 DOI: 10.1097/jcn.0000000000001046] [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: 09/26/2023]
Abstract
BACKGROUND Medical management and surgical improvement techniques permit persons with congenital heart conditions to live longer. Adults with congenital heart disease (CHD) have more childbearing options than previously available to them. However, there is an increased childbearing risk associated with certain types of CHD. Minimal investigation has been given to the childbearing decision-making experiences and adaptation of women with CHD. OBJECTIVE The aim of this study was to gain insight into the childbearing decision-making and adaptation experiences of women with CHD. METHODS Using a narrative inquiry approach, 17 adult women with CHD of any severity, of childbearing age, who had, within the last 5 years, made a decision regarding childbearing, were interviewed. In this study, we applied the key components of the Roy Adaptation Model to understand childbearing decision-making experiences and their adaptation. Data were analyzed using thematic analysis. RESULTS Data analysis revealed 5 stages of childbearing decision making: (1) prologue: stimulus to consider childbearing; (2) exploring childbearing options; (3) considering childbearing options; (4) choosing to bear or not to bear a child; and (5) epilogue: adapting to the childbearing decision. Adaptation occurred in the areas of self-concept (ie, emotional adaptation), role function (ie, relational adaptation), and interdependence (ie, interactional adaptation). CONCLUSION Childbearing decision making is a complex personal decision that is carefully and deliberately made. Women with CHD long for children and seek childbearing information from various resources and may experience grief regarding the inability to bear children. A greater understanding of childbearing decision making can be useful in addressing women's childbearing emotions and assist with adaptation to childbearing needs.
Collapse
|
4
|
Harrison DJ, Kay J, Jacobsen RM, Londono-Obregon C, Yeung E, Kelly SL, Poteet A, Levek C, Landzberg MJ, Wallrich M, Khanna A. The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD. Am J Cardiol 2024; 219:9-16. [PMID: 38458583 DOI: 10.1016/j.amjcard.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria in assessing patient characteristics and experiences with trauma-focused treatment. Surveys were offered to outpatients over a 6-month enrollment period to be completed by way of a QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo social support scale, adverse childhood experiences survey, and the PTSD checklist for DSM-5. Of 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%) using a PTSD checklist for DSM-5 cut-off score of ≥31. A positive PTSD screen was associated with younger age, nonwhite race, presence of heart failure, lower New York Heart Association functional class, lower linear quality of life score, lower Oslo social support scale score, an insecure caregiver relation, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions were not associated with PTSD, although having undergone no cardiac surgeries until adulthood (aged ≥18 years) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14 of 48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. A total of 18 patients (38%) reported currently having a mental health provider. A total of 30 patients (62%) had heard of at least 1 evidence-based trauma-informed therapy, and 14 (29%) had tried at least 1. In conclusion, using the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few patients with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.
Collapse
Affiliation(s)
- David J Harrison
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | - Joseph Kay
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Roni M Jacobsen
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Camila Londono-Obregon
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth Yeung
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah L Kelly
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | - Ann Poteet
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado
| | - Claire Levek
- University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Landzberg
- Boston Adult Congenital Heart (B.A.C.H.) Program, Boston Children's Hospital, Brigham and Women's Hospital, Boston, Massachisetts
| | - Molly Wallrich
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado
| | - Amber Khanna
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Children's Hospital Colorado, Aurora, Colorado
| |
Collapse
|
5
|
Sholler GF, Selbie LA, Tallon M, Keating J, Ayer J, Burchill L, Cheung MMH, Cordina R, Culnane E, Donovan S, Eastaugh L, Elliott C, Fletcher J, Justo RN, Kasparian NA, Kelly A, Morsman D, Nicolae M, Orr Y, Pendrick E, Ramsay JM, Reményi B, Shipton S, Weintraub RG, Van Wijk E, Wheaton G, Venugopal P. Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards). 1st Edition. Heart Lung Circ 2024; 33:153-196. [PMID: 38453293 DOI: 10.1016/j.hlc.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/09/2024]
Abstract
These first Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards) have been developed to inform the healthcare requirements for CoHD services and enable all Australian patients, families and carers impacted by CoHD (paediatric CoHD and adult congenital heart disease [ACHD]) to live their best and healthiest lives. The CoHD Standards are designed to provide the clarity and certainty required for healthcare services to deliver excellent, comprehensive, inclusive, and equitable CoHD care across Australia for patients, families and carers, and offer an iterative roadmap to the future of these services. The CoHD Standards provide a framework for excellent CoHD care, encompassing key requirements and expectations for whole-of-life, holistic and connected healthcare service delivery. The CoHD Standards should be implemented in health services in conjunction with the National Safety and Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Health Care. All healthcare services should comply with the CoHD Standards, as well as working to their organisation's or jurisdiction's agreed clinical governance framework, to guide the implementation of structures and processes that support safe care.
Collapse
Affiliation(s)
- Gary F Sholler
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Lisa A Selbie
- HeartKids Ltd, Parramatta, NSW, Australia; School of Biotechnology & Biomolecular Sciences University of NSW, Sydney, NSW, Australia and Johns Hopkins University, Baltimore, MD, USA
| | - Mary Tallon
- HeartKids Ltd, Parramatta, NSW, Australia; Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | | | - Julian Ayer
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Luke Burchill
- The Royal Melbourne Hospital, Melbourne, Vic, Australia and Mayo Clinic, Rochester, New York, NY, USA
| | - Michael M H Cheung
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Evelyn Culnane
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Lucas Eastaugh
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Jeffery Fletcher
- Queensland Paediatric Specialists, Southport, Qld, Australia; Department of Paediatrics, The Tweed Hospital, Tweed Heads, NSW, Australia and Griffith University, Brisbane, Qld, Australia
| | - Robert N Justo
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia; Queensland Paediatric Cardiac Research, Children's Health Queensland, South Brisbane, Qld, Australia
| | - Nadine A Kasparian
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Ohio, OH, USA
| | - Andrew Kelly
- Women's and Children's Hospital, North Adelaide, SA, Australia
| | | | - Mugur Nicolae
- The University of Queensland, Herston, Qld, Australia; Mater Hospital Services, Brisbane, Qld, Australia
| | - Yishay Orr
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | | | | | - Bo Reményi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT and Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Robert G Weintraub
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Elsa Van Wijk
- HeartKids Ltd, Parramatta, NSW, Australia; Australian Institute of Company Directors, NSW, Australia
| | - Gavin Wheaton
- Women's and Children's Hospital, North Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Prem Venugopal
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia
| |
Collapse
|
6
|
Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Estensen ME, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Jameson SM, Callus E, Kutty S, Oechslin E, Van Bulck L, Moons P. Anxiety and Depression in Adults With Congenital Heart Disease. J Am Coll Cardiol 2024; 83:430-441. [PMID: 38233017 DOI: 10.1016/j.jacc.2023.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND A comprehensive understanding of adult congenital heart disease outcomes must include psychological functioning. Our multisite study offered the opportunity to explore depression and anxiety symptoms within a global sample. OBJECTIVES In this substudy of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study), the authors we investigated the prevalence of elevated depression and anxiety symptoms, explored associated sociodemographic and medical factors, and examined how quality of life (QOL) and health status (HS) differ according to the degree of psychological symptoms. METHODS Participants completed the Hospital Anxiety and Depression Scale, which includes subscales for symptoms of anxiety (HADS-A) and depression (HADS-D). Subscale scores of 8 or higher indicate clinically elevated symptoms and can be further categorized as mild, moderate, or severe. Participants also completed analogue scales on a scale of 0 to 100 for QOL and HS. Analysis of variance was performed to investigate whether QOL and HS differed by symptom category. RESULTS Of 3,815 participants from 15 countries (age 34.8 ± 12.9 years; 52.7% female), 1,148 (30.1%) had elevated symptoms in one or both subscales: elevated HADS-A only (18.3%), elevated HADS-D only (2.9%), or elevations on both subscales (8.9%). Percentages varied among countries. Both QOL and HS decreased in accordance with increasing HADS-A and HADS-D symptom categories (P < 0.001). CONCLUSIONS In this global sample of adults with congenital heart disease, almost one-third reported elevated symptoms of depression and/or anxiety, which in turn were associated with lower QOL and HS. We strongly advocate for the implementation of strategies to recognize and manage psychological distress in clinical settings. (Patient-Reported Outcomes in Adults With Congenital Heart Disease [APPROACH-IS]; NCT02150603).
Collapse
Affiliation(s)
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Education, Toyo University, Tokyo, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- IU Health Adult Congenital Heart Disease Program, IU School of Medicine, Indianapolis, Indiana, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Mette-Elise Estensen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Department of Health Sciences, University West, Trollhättan, Sweden; The Queen Silva Children's Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samuel Menahem
- Department of Paediatrics and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexandra Soufi
- Department of Cardiac Rehabilitation, Médipôle Hôpital Mutualiste, Lyon-Villeurbanne, France
| | - Susan M Jameson
- Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, California, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
7
|
Leo DG, Islam U, Lotto RR, Lotto A, Lane DA. Psychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev 2023; 10:CD004372. [PMID: 37787122 PMCID: PMC10546482 DOI: 10.1002/14651858.cd004372.pub3] [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] [Indexed: 10/04/2023]
Abstract
BACKGROUND Despite improvements in medical care, the quality of life of adults and adolescents with congenital heart disease remains strongly affected by their condition, often leading to depression. Psychotherapy, cognitive behavioural therapy, and other talking therapies may be effective in treating depression in both 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 evaluate the effects (both harms and benefits) of psychological interventions for reducing symptoms of depression in adolescents (aged 10 to 17 years) and adults with congenital heart disease. Psychological interventions include cognitive behavioural therapy, psychotherapy, or 'talking/counselling' therapy for depression. SEARCH METHODS We updated searches from the 2013 Cochrane Review by searching CENTRAL, four other databases, and Conference Proceedings Citation Index to 7 March 2023, and two clinical trial registers to February 2021. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychological interventions to no intervention in the congenital heart disease population, aged 10 years and older, with depression. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts, and independently assessed full-text reports for inclusion. Further information was sought from the authors if needed. Data were extracted in duplicate. We used standard Cochrane methods. Our primary outcome was a change in depression. Our secondary outcomes were: acceptability of treatment, quality of life, hospital re-admission, non-fatal cardiovascular events, cardiovascular behavioural risk factor, health economics, cardiovascular mortality, all-cause mortality. We used GRADE to assess the certainty of evidence for our primary outcome only. MAIN RESULTS We identified three new RCTs (480 participants). Participants were adults with congenital heart disease. Included studies varied in intervention length (90 minutes to 3 months) and follow-up (3 to 12 months), with depression assessed post-intervention and at follow-up. Risk of bias assessment identified an overall low risk of bias for the main outcome of depression. Psychological interventions (talking/counselling therapy) may reduce depression more than usual care at both three-month (mean difference (MD) -1.07, 95% confidence interval (CI) -1.84 to -0.30; P = 0.006; I2 = 0%; 2 RCTs, 156 participants; low-certainty evidence), and 12-month follow-up (MD -1.02, 95% CI -1.92 to -0.13; P = 0.02; I2 = 0%; 2 RCTs, 287 participants; low-certainty evidence). There was insufficient evidence to draw conclusions about the impact of psychological interventions on quality of life. None of the included studies reported on our other outcomes of interest. Due to the low number of studies included, we did not undertake any subgroup analyses. One study awaits classification. AUTHORS' CONCLUSIONS Psychological interventions may reduce depression in adults with congenital heart disease compared to usual care. However, the certainty of the evidence is low. Further research is needed to establish the role of psychological interventions in this population, defining the optimal duration, method of administration, and number of sessions required to obtain the greatest benefit.
Collapse
Affiliation(s)
- Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Umar Islam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Robyn R Lotto
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Attilio Lotto
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
8
|
Celermajer DS, Baker DW, Cordina RL, Gatzoulis M, Broberg CS. Common diagnostic errors in adults with congenital heart disease. Eur Heart J 2023; 44:3217-3227. [PMID: 36527303 DOI: 10.1093/eurheartj/ehac717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/07/2022] [Accepted: 11/20/2022] [Indexed: 09/08/2023] Open
Abstract
Owing to the great advances in the care for children with congenital heart disease by paediatric cardiac surgeons and cardiologists, there are ever increasing numbers of patients with congenital heart disease who reach adult life. At some stage during the late teenage years or soon after, these patients 'transition' from paediatric cardiac care to surveillance by cardiologists who look after adults. Many such specialists, however, are more familiar with commoner acquired heart problems such as coronary disease, heart failure, and arrhythmia in structurally normal hearts and less familiar with congenital heart disease. For this reason, international guidelines have suggested that the care of young adults with congenital heart disease take place in designated specialist adult congenital heart disease centres. It remains very important, however, for general cardiologists to have a good understanding of many aspects of adult congenital heart disease, including common pitfalls to avoid and, importantly, when to refer on, to a specialist centre. To help healthcare providers across the spectrum of cardiology practice to address common themes in adult congenital heart disease, this state-of-the-art review provides a series of case vignettes to illustrate frequent diagnostic problems that we have seen in our tertiary-level adult congenital heart disease centres, which are sometimes encountered in general cardiology settings. These include commonly 'missed' diagnoses, or errors with diagnosis or management, in these often very complex patients.
Collapse
Affiliation(s)
- David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - David W Baker
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Rachael L Cordina
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Michael Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
9
|
Marcil MJ, Houchi C, Nadarajah K, Khairy P, Mageau GA, Marin MF, Cossette M, Dubé MP, Chaix MA, Mongeon FP, Dore A, Mondésert B, Ibrahim R, Brouillette J. The Influence of Illness Perception and Coping on Anxiety in Adults With Congenital Heart Disease. JACC. ADVANCES 2023; 2:100425. [PMID: 38939437 PMCID: PMC11198082 DOI: 10.1016/j.jacadv.2023.100425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/29/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2024]
Abstract
Background Up to one-half of adults with congenital heart disease (CHD) experience psychological distress, including anxiety. Objectives This paper sought to: 1) assess the contribution of illness perception in explaining anxiety symptoms beyond sociodemographic and medical variables in adults with CHD; and 2) investigate the potential mediating effect of coping style. Methods CHD adult patients were recruited at Montreal Heart Institute between June 2019 and April 2021 for this cross-sectional study. Participants responded to self-reported questionnaires (Hospital Anxiety and Depression Scale, Brief Illness Perception Questionnaire, and Brief COPE). Medical characteristics (CHD complexity, NYHA functional class, and cardiac devices) were collected from medical records. We conducted hierarchical multiple linear regression and mediation analyses. Results Of the 223 participants (mean age 46 ± 14 years, 59% women), 15% had clinically significant anxiety symptoms. Medical and sociodemographic variables explained 15% of the variation in anxiety symptoms. Adding illness perception explained an additional 18% of the variation in anxiety. This R2 change was significant (F[1,188] = 49.06, P < 0.0001). Illness perception explained more variance (18%) than medical and sociodemographic variables combined. A more threatening perception of illness was associated with greater anxiety symptoms (β = 0.45, P < 0.0001). Furthermore, illness perception was associated with coping, which was linked to reduced anxiety symptoms. Coping response style accounted for 20% of the total effect of illness perception on anxiety. Conclusions Illness perception and coping are associated with anxiety in adults with CHD. Future initiatives should assess whether targeting these potentially modifiable factors effectively prevents or mitigates anxious symptoms in adults with CHD.
Collapse
Affiliation(s)
- Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Cylia Houchi
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | | | - Paul Khairy
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Geneviève A. Mageau
- Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montréal, Québec, Canada
| | - Marie-France Marin
- Department of Psychology, Faculty of Social Sciences and Humanities, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Centre, A Division of the Montreal Heart Institute, Montréal, Québec, Canada
| | - Marie-Pierre Dubé
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Marie-A. Chaix
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - François-Pierre Mongeon
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Annie Dore
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Mondésert
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Reda Ibrahim
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
10
|
Shalen EF, McGrath LB, Bhamidipati CM, Garcia IC, Ramsey K, Broberg CS, Khan AM. Substance Use Disorders Are Prevalent in Adults With Congenital Heart Disease and Are Associated With Increased Healthcare Use. Am J Cardiol 2023; 192:24-30. [PMID: 36709526 DOI: 10.1016/j.amjcard.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
Adults with congenital heart disease (CHD) represent a heterogeneous group with significant long-term health risks. Previous studies have demonstrated a high prevalence of psychiatric disorders among adults with CHD; however, little is known about the frequency of co-morbid substance use disorders (SUDs) in patients with CHD. The Oregon All Payer All Claims (APAC) database for the years 2014 to 2017 was queried for adults aged 18 to 65 years with International Classification of Diseases, Ninth or Tenth Revision codes consistent with CHD. Alcohol and substance use were identified by International Classification of Diseases codes for use or dependence and classified in mutually exclusive categories of none, alcohol only, and other drugs (with or without alcohol). Descriptive statistics were used to characterize prevalence and chi-square tests were used to test for associations between variables. A total of 12,366 adults with CHD were identified. The prevalence of substance use was 15.7%. The prevalence of isolated alcohol use was 3.9%. A total of 19% of patients used tobacco. Insurance type, presence of a concurrent mental health diagnosis, and age were associated with substance use, whereas CHD complexity was not. Cardiovascular co-morbidities were more common in patients with reported substance use. Inpatient and emergency care use were higher in those with SUD. In conclusion, this study of substance and alcohol use among adults with CHD demonstrates high rates of co-morbid SUD, particularly among patients with mental health disorders and Medicaid insurance, associated with increased healthcare utilization. We identify a population in need of targeted interventions to improve long-term health.
Collapse
Affiliation(s)
- Evan F Shalen
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute
| | - Lidija B McGrath
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute
| | | | | | - Katrina Ramsey
- Division of Biostatistics and Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Craig S Broberg
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute
| | - Abigail M Khan
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute.
| |
Collapse
|
11
|
Psychosocial Risk Factors for Health-Related Quality of Life in Adult Congenital Heart Disease. J Cardiovasc Nurs 2023; 38:70-83. [PMID: 36508238 DOI: 10.1097/jcn.0000000000000897] [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: 12/15/2022]
Abstract
BACKGROUND There is variability in the impact of adult congenital heart disease (ACHD) on health-related quality of life (HRQoL). A greater insight into the impact of ACHD may be gained from investigating HRQoL in various diagnostic groups and considering the importance of psychosocial risk factors for poor HRQoL. OBJECTIVE We compared the HRQoL of people with ACHD with normative data from the general population and among 4 diagnostic groups and identified risk factors for poor HRQoL in ACHD from a comprehensive set of sociodemographic, clinical, and psychosocial factors. METHODS We conducted a cross-sectional study with 303 participants from 4 diagnostic groups Simple, Tetralogy of Fallot, Transposition of the Great Arteries, Single Ventricle who completed measures of illness perceptions, coping, social support, mood, and generic and disease-specific HRQoL. Data were analyzed using 1-sample t tests, analysis of variance, and hierarchical multiple regressions. RESULTS There was diminished psychosocial HRQoL in the Simple group compared with the general population. Consistently significant risk factors for poor HRQoL included younger age, a perception of more severe symptoms due to ACHD, depression, and anxiety. Clinical factors were poor predictors of HRQoL. CONCLUSIONS The findings highlight the need to develop intervention studies aiming to improve HRQoL in people with ACHD and the routine assessment of illness perceptions and mood problems during key periods in people's lives. This will help address patient misconceptions that could be tackled by clinicians or specialist nurses during routine outpatient appointments and identify people in need of psychological support.
Collapse
|
12
|
Davis KA, Dietrich MS, Gilmer MJ, Fuchs DC, Akard TF. Postoperative opioid administration and post-traumatic stress symptoms in preschool children after cardiac surgery. J Pediatr Nurs 2023; 68:44-51. [PMID: 36333168 DOI: 10.1016/j.pedn.2022.10.005] [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] [Received: 02/03/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to explore relationships between postoperative opioid administration and posttraumatic stress symptoms (PTSS) in preschool-aged children surviving cardiac surgery. DESIGN AND METHODS This was a cross-sectional, descriptive study using survey administration and medical chart review. Primary caregivers of children aged three to six years who underwent cardiac surgery at our institution between 2018 and 2020 were invited to participate. Opioid administration was calculated according to morphine milligram equivalents and indexed to the child's body weight. Caregivers completed the Young Child Posttraumatic Stress Disorder Checklist to explore child PTSS. We used correlational methods to assess the strength and direction of relationships between postoperative opioid administration and child PTSS. RESULTS We did not find a statistically significant relationship between total postoperative opioid administration and child PTSS. When analyzing individual opioid agents, morphine did show a significant inverse relationship to YCPC scores (rs = -.57, p = .017) in children with single ventricle physiology. CONCLUSIONS Total postoperative opioid administration was not statistically significantly related to child PTSS in our sample. Differing patterns of association were noted among children with single- versus bi-ventricular physiology. Postoperative morphine administration was favorably associated with PTSS in children with single-ventricle physiology. PRACTICE IMPLICATIONS Nurses caring for preschool children who undergo cardiac surgery should anticipate the potential development of PTSS in their patients. Studies using larger sample sizes and longitudinal design are needed to replicate the significant relationship between morphine administration and PTSS in preschoolers with single-ventricle physiology.
Collapse
Affiliation(s)
- Kelly A Davis
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA; Division of Pediatric Critical Care, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA; Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Drive Nashville, TN 37232, USA
| | - Mary Jo Gilmer
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA
| | - D Catherine Fuchs
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Terrah Foster Akard
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA
| |
Collapse
|
13
|
Daily life and psychosocial functioning of adults with congenital heart disease: a 40-53 years after surgery follow-up study. Clin Res Cardiol 2022:10.1007/s00392-022-02132-w. [PMID: 36534138 PMCID: PMC9761041 DOI: 10.1007/s00392-022-02132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Nowadays, more than 90% of patients with congenital heart disease (CHD) reach adulthood. However, knowledge about their psychosocial functioning is limited. METHODS Longitudinal cohort study of patients (n = 204, mean age: 50 years, 46.1% female) who were operated during childhood (< 15 years) between 1968 and 1980 for one of the following diagnoses: atrial septal defect, ventricular septal defect, pulmonary stenosis, tetralogy of Fallot or transposition of the great arteries. Psychosocial functioning was measured every 10 years, using standardized and validated questionnaires. Results were compared with the general Dutch population and over time. RESULTS After a median follow-up of 45 [40-53] years adults with CHD had a significantly lower educational level, occupation level and employment rate, but better health-related quality of life and emotional functioning compared with normative data. Patients with moderate/severe defects reported significantly more self-perceived physical restrictions and lack of physical strength due to their CHD. Compared to 2011, in 2021 patients considered their CHD as more severe and they felt more often disadvantaged. CONCLUSIONS Overall, despite a lower education, occupation level and employment rate, our sample of patients with CHD had a positive perception of their life and their psychosocial functioning was even better than the norm. Although the quality of life was very good, their view on their disease was more pessimistic than 10 years ago, especially for patients with moderate/severe CHD.
Collapse
|
14
|
Pelosi C, Kauling R, Cuypers J, van den Bosch A, Bogers A, Helbing W, Hesselink JR, Legerstee J, Utens E. Development of psychopathology in adults with congenital heart disease: A 40–53 years follow-up study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
15
|
Janzen ML, LeComte K, Sathananthan G, Wang J, Kiess M, Chakrabarti S, Grewal J. Psychological Distress in Adults With Congenital Heart Disease Over the COVID-19 Pandemic. J Am Heart Assoc 2022; 11:e023516. [PMID: 35470701 PMCID: PMC9238616 DOI: 10.1161/jaha.121.023516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background This study sought to better understand the experiences of adults with congenital heart disease throughout the pandemic. Objectives were to determine (1) psychological distress before and throughout the pandemic; (2) changes in day-to-day functioning; and (3) the percentage of adults with congenital heart disease who experienced COVID-19 related symptoms, underwent testing, and tested positive. Methods and Results This was a cross-sectional study paired with retrospective chart review. A web-based survey was distributed to patients between December 2020 and January 2021. Patients reported on psychological distress across 5 categories (Screening Tool for Psychological Distress; depression, anxiety, stress, anger, and lack of social support), whether they experienced symptoms of COVID-19 and/or sought testing, and changes to their work and social behavior. Five hundred seventy-nine survey responses were received, of which 555 were linked to clinical data. Patients were aged 45±15 years. The proportion of patients reporting above-threshold values for all Screening Tool for Psychological Distress items significantly increased during the early pandemic compared with before the pandemic. Stress returned to baseline in December 2020/January 2021, whereas all others remained elevated. Psychological distress decreased with age, and women reported persistently elevated stress and anxiety compared with men during the pandemic. A consistent trend was not observed with regard to American College of Cardiology/American Heart Association anatomic and physiologic classification. Fifty (9%) patients lost employment because of a COVID-19-related reason. COVID-19 symptoms were reported by 145 (25%) patients, 182 (31%) sought testing, and 10 (2%) tested positive. Conclusions A substantial proportion of adults with congenital heart disease reported clinically significant psychological distress during the pandemic.
Collapse
Affiliation(s)
- Mikyla L Janzen
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Karen LeComte
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Gnalini Sathananthan
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Jia Wang
- Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire University of British Columbia Vancouver British Columbia Canada
| | - Marla Kiess
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Santabhanu Chakrabarti
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Jasmine Grewal
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program Division of Cardiology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| |
Collapse
|
16
|
Videoconference-delivered Mind-Body Resiliency Training in Adults with congenital heart disease: A pilot feasibility trial. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
17
|
Simeone RM, Downing KF, Bobo WV, Grosse SD, Khanna AD, Farr SL. Post-traumatic stress disorder, anxiety, and depression among adults with congenital heart defects. Birth Defects Res 2022; 114:124-135. [PMID: 34935303 PMCID: PMC8828688 DOI: 10.1002/bdr2.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Due to invasive treatments and stressors related to heart health, adults with congenital heart defects (CHDs) may have an increased risk of post-traumatic stress disorder (PTSD), anxiety, and/or depressive disorders. Our objectives were to estimate the prevalence of these disorders among individuals with CHDs. METHODS Using IBM® MarketScan® Databases, we identified adults age 18-49 years with ≥2 outpatient anxiety/depressive disorder claims on separate dates or ≥1 inpatient anxiety/depressive disorder claim in 2017. CHDs were defined as ≥2 outpatient CHD claims ≥30 days apart or ≥1 inpatient CHD claim documented in 2007-2017. We used log-binomial regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between CHDs and anxiety/depressive disorders. RESULTS Of 13,807 adults with CHDs, 12.4% were diagnosed with an anxiety or depressive disorder. Adults with CHDs, compared to the 5,408,094 without CHDs, had higher prevalence of PTSD (0.8% vs. 0.5%; aPR: 1.5 [CI: 1.2-1.8]), anxiety disorders (9.9% vs. 7.5%; aPR: 1.3 [CI: 1.3-1.4]), and depressive disorders (6.3% vs. 4.9%; aPR: 1.3 [CI: 1.2-1.4]). Among individuals with CHDs, female sex (aPR range: 1.6-3.3) and inpatient admission (aPR range 1.1-1.9) were associated with anxiety/depressive disorders. CONCLUSION Over 1 in 8 adults with CHDs had diagnosed PTSD and/or other anxiety/depressive disorders, 30-50% higher than adults without CHDs. PTSD was rare, but three times more common in women with CHDs than men. Screening and referral for services for these conditions in people with CHDs may be beneficial.
Collapse
Affiliation(s)
- Regina M. Simeone
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amber D. Khanna
- Department of Internal Medicine, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Department of Pediatrics, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
18
|
Cocomello L, Dimagli A, Biglino G, Cornish R, Caputo M, Lawlor DA. Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis. BMC Cardiovasc Disord 2021; 21:549. [PMID: 34798837 PMCID: PMC8603574 DOI: 10.1186/s12872-021-02349-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults. METHOD Studies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD. RESULT Out of 1537 articles screened, we identified 11 (N = 104,585 participants, 10,487 with CHD), 10 (N = 167,470 participants, 11,820 with CHD), and 8 (N = 150,813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR = 1.38, 95% CI [1.16, 1.65]), complete secondary education (OR = 1.33, 95% CI [1.09, 1.61]) or vocational training (OR = 1.11, 95% CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity. CONCLUSION This systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.
Collapse
Affiliation(s)
- Lucia Cocomello
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | | | - Giovanni Biglino
- Bristol Medical School, Tyndall Avenue, Bristol, BS8 1UD, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rosie Cornish
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, Terrell St, Bristol, BS2 8 ED, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| |
Collapse
|
19
|
Leibold A, Eichler E, Chung S, Moons P, Kovacs AH, Luyckx K, Apers S, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, White K, Callus E, Kutty S, Fernandes SM. Pain in adults with congenital heart disease - An international perspective. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
20
|
The effects of rational emotive behavior therapy for depressive symptoms in adults with congenital heart disease. Heart Lung 2021; 50:906-913. [PMID: 34411872 DOI: 10.1016/j.hrtlng.2021.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/06/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over 30% of adults with congenital heart disease (CHD) experience depression. OBJECTIVES To evaluate the effectiveness of Rational Emotive Behavior Therapy (REBT) in reducing depressive symptoms in adults with CHD. METHODS Forty-two adults with CHD were recruited from an outpatient clinic and randomized to a study group (n = 21), which comprised 8-weekly group-based counseling sessions, or a control group (n = 21), which received usual care. REBT effectiveness was examined using the Hamilton Depression Rating Scale, Beck Depression Inventory, Shorten General Attitude and Belief Scale, and salivary cortisol levels before therapy, after the last session, and at follow-up 4 weeks later. RESULTS Average participant ages were 30.1 ± 7.58 and 33.3 ± 7.1 years in study and control groups, respectively; 52.4% of participants in each group were female. After REBT, depression (p < 0.001), irrational beliefs (p < 0.001), and salivary cortisol levels (p = 0.006) were significantly lower in the study group than in the control group. Effects of REBT in the study group remained consistent at the 4-week follow-up. CONCLUSION REBT may be effective in reducing depression in adults with CHD.
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients. RECENT FINDINGS Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents with CHD reported greater health anxiety than community peers. Health anxiety was commonly reported among adults with CHD presenting for psychological assessment. It was linked with older age, trait anxiety, perceived parental overprotection and greater CHD complexity in one study. SUMMARY Adults with CHD face many potential health-related stressors, including cardiac symptoms, treatments and interventions throughout the lifespan (including surgeries and other invasive procedures), the impact of CHD on daily lives and longer-term health expectations. Providers should be aware that heart-focused anxiety among patients is understandable and perhaps common. Patient-centred education and psychological intervention should be integrated within a comprehensive approach to long-term disease management.
Collapse
|
22
|
Gonzalez VJ, Kimbro RT, Cutitta KE, Shabosky JC, Bilal MF, Penny DJ, Lopez KN. Mental Health Disorders in Children With Congenital Heart Disease. Pediatrics 2021; 147:peds.2020-1693. [PMID: 33397689 PMCID: PMC7849200 DOI: 10.1542/peds.2020-1693] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Data on anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are lacking for youth with congenital heart disease (CHD), particularly those with simple CHD. This study aims to characterize these disorders in youth with CHD compared to those without CHD. METHODS A comparative cross-sectional study was conducted by using the electronic medical records of a large tertiary care hospital between 2011 and 2016. Inclusion criteria were youth aged 4 to 17 years with >1 hospitalization or emergency department visits. Exclusion criteria were patients with arrhythmias or treatment with clonidine and/or benzodiazepines. The primary predictor variable was CHD type: simple, complex nonsingle ventricle, and complex single ventricle. The primary outcome variable was a diagnosis and/or medication for anxiety and/or depression or ADHD. Data were analyzed by using logistic regression (Stata v15; Stata Corp, College Station, TX). RESULTS We identified 118 785 patients, 1164 with CHD. Overall, 18.2% (n = 212) of patients with CHD had a diagnosis or medication for anxiety or depression, compared with 5.2% (n = 6088) of those without CHD. All youth with CHD had significantly higher odds of anxiety and/or depression or ADHD. Children aged 4 to 9 years with simple CHD had ∼5 times higher odds (odds ratio: 5.23; 95% confidence interval: 3.87-7.07) and those with complex single ventricle CHD had ∼7 times higher odds (odds ratio: 7.46; 95% confidence interval: 3.70-15.07) of diagnosis or treatment for anxiety and/or depression. Minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety and/or depression or ADHD, regardless of disease severity. CONCLUSIONS Youth with CHD of all severities have significantly higher odds of anxiety and/or depression and ADHD compared to those without CHD. Screening for these conditions should be considered in all patients with CHD.
Collapse
Affiliation(s)
- Vincent J. Gonzalez
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | | | - Katherine E. Cutitta
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - John C. Shabosky
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Mohammad F. Bilal
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Daniel J. Penny
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Keila N. Lopez
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| |
Collapse
|
23
|
Kovacs AH, Bellinger DC. Neurocognitive and psychosocial outcomes in adult congenital heart disease: a lifespan approach. Heart 2020; 107:159-167. [PMID: 32887738 DOI: 10.1136/heartjnl-2016-310862] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Adrienne H Kovacs
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Kops SA, Andrews JG, Klewer SE, Seckeler MD. Effect of comorbid neuropsychiatric disorders on children and adolescents undergoing surgery for moderate and severe congenital heart disease. J Card Surg 2020; 35:3048-3052. [PMID: 32840922 DOI: 10.1111/jocs.14972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children and adolescents with congenital heart disease (CHD) are at an increased risk of neuropsychiatric disorders (NPDs). The purpose of this study is to determine how a comorbid NPD affects hospital outcomes and costs for CHD patients undergoing cardiac surgery. METHODS Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project Kids' Inpatient Databases for admissions 10 to 21 years old with an ICD-9 code for moderate or severe CHD and a procedure code for cardiopulmonary bypass as a marker for cardiac surgery; admissions with syndromes that could be associated with NPD were excluded. Demographics, hospital outcomes, and charges were compared between admissions with and without NPD ICD-9 codes using analysis of variance, independent samples Kruskal-Wallis, and χ2 , as appropriate. RESULTS There were 4768 admissions with CHD and cardiac surgery: 4285 (90%) with no NPD, 93 (2%) with cognitive deficits, 390 (8%) with mood/behavior deficits. Patients with NPD had a longer length of stay and higher mean charges (P < .001 for both). Patients with mood/behavior deficits were older and patients with cognitive deficits were more likely female (P < .001 for both). CONCLUSIONS Children and adolescents with moderate or severe CHD and NPD who undergo cardiac surgery incur longer hospital stays and higher charges. Recognizing and addressing the underlying NPDs may be important to improve postoperative progression for children and adolescents with CHD hospitalized for cardiac surgery.
Collapse
Affiliation(s)
- Samantha A Kops
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Jennifer G Andrews
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| |
Collapse
|
25
|
The emerging psychosocial profile of the adult congenital heart disease patient. Curr Opin Organ Transplant 2020; 25:506-512. [DOI: 10.1097/mot.0000000000000802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
26
|
Abstract
BACKGROUND Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation. METHODS We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients' employment status during each year. RESULTS The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001). CONCLUSION In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18-64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.
Collapse
|
27
|
Fernandes SM, Marelli A, Hile DM, Daniels CJ. Access and Delivery of Adult Congenital Heart Disease Care in the United States. Cardiol Clin 2020; 38:295-304. [DOI: 10.1016/j.ccl.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
28
|
Ortinau CM, Shimony JS. The Congenital Heart Disease Brain: Prenatal Considerations for Perioperative Neurocritical Care. Pediatr Neurol 2020; 108:23-30. [PMID: 32107137 PMCID: PMC7306416 DOI: 10.1016/j.pediatrneurol.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/21/2019] [Accepted: 01/05/2020] [Indexed: 12/17/2022]
Abstract
Altered brain development has been highlighted as an important contributor to adverse neurodevelopmental outcomes in children with congenital heart disease. Abnormalities begin prenatally and include micro- and macrostructural disturbances that lead to an altered trajectory of brain growth throughout gestation. Recent progress in fetal imaging has improved understanding of the neurobiological mechanisms and risk factors for impaired fetal brain development. The impact of the prenatal environment on postnatal neurological care has also gained increased focus. This review summarizes current data on the timing and pattern of altered prenatal brain development in congenital heart disease, the potential mechanisms of these abnormalities, and the association with perioperative neurological complications.
Collapse
Affiliation(s)
- Cynthia M Ortinau
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
| | - Joshua S Shimony
- Mallinkrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
29
|
Anxiety and Depression in Adults with Congenital Heart Disease: When to Suspect and How to Refer. Curr Cardiol Rep 2019; 21:145. [DOI: 10.1007/s11886-019-1237-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
30
|
Ludmir J, Steiner JM, Wong HN, Kloosterboer A, Leong J, Aslakson RA. Palliative Care Opportunities Among Adults With Congenital Heart Disease-A Systematic Review. J Pain Symptom Manage 2019; 58:891-898. [PMID: 31404639 DOI: 10.1016/j.jpainsymman.2019.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT Little is known about advance care planning (ACP) and palliative care needs among adults with congenital heart disease (ACHD). OBJECTIVES The objective of this study was to identify and synthesize studies concerning palliative care among ACHD patients. METHODS We searched five electronic databases (PubMed, Embase, SCOPUS, Web of Science, and CINAHL) using the keywords palliative care and congenital heart disease. Inclusion criteria were adults (age > 18 years) with congenital heart disease and publications in English through March 3, 2019. RESULTS Our search yielded 2872 studies, and after removal of duplicates, we screened 2319 abstracts and identified seven for inclusion. Study findings were grouped into three domains: ACP, symptomatology, and end-of-life care. Among the five cross-sectional studies, only 1%-28% of ACHD patients recalled participating in ACP discussions with their doctors but 69%-78% reported a strong interest and desire to participate in ACP. In one study, 46% (n = 67) of patients had elevated anxiety symptoms (Hospital Anxiety and Depression Scale [HADS-A] ≥ 8) and 11% (n = 15) had elevated depressive symptoms (HADS-A ≥ 8). ACHD patients who had a documented goals of care conversation before cardiac decompensation had a lower incidence of resuscitation and aggressive treatments at end of life (12% [n = 3] vs. 100% [n = 12], P < 0.001). CONCLUSION While few ACHD patients complete advance directives, our findings support that many ACHD patients recognize the value of initiating end-of-life and goals of care conversations early on in the course of illness. Future studies investigating communication and implementation strategies of ACP as well as the symptom experience of patients with ACHD are needed.
Collapse
Affiliation(s)
- Jonathan Ludmir
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California, USA.
| | - Jill M Steiner
- Division of Cardiology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Amy Kloosterboer
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Jason Leong
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Rebecca A Aslakson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, California, USA; Palliative Care Section, Division of Primary Care and Population Health, Department of Medicine, Stanford University Medical Center, Stanford, California, USA
| | | |
Collapse
|