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Shibbani K, Abdulkarim A, Budts W, Roos-Hesselink J, Müller J, Shafer K, Porayette P, Zaidi A, Kreutzer J, Alsaied T. Participation in Competitive Sports by Patients With Congenital Heart Disease: AHA/ACC and EAPC/ESC/AEPC Guidelines Comparison. J Am Coll Cardiol 2024; 83:772-782. [PMID: 38355248 DOI: 10.1016/j.jacc.2023.10.037] [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: 08/24/2023] [Revised: 09/27/2023] [Accepted: 10/20/2023] [Indexed: 02/16/2024]
Abstract
Sports participation in patients with congenital heart disease is an evolving subject. The American Heart Association/American College of Cardiology released a set of guidelines that advise the type and level of sports participation based primarily on anatomical defects with secondary consideration given to hemodynamic effects. Recently, the European Association of Preventive Cardiology/European Society of Cardiology/Association for European Paediatric and Congenital Cardiology offered a contrasting approach to sports participation that is based on hemodynamic and electrophysiological profiles of each patient, regardless of anatomical consideration. These guidelines are drastically different in their approaches but do have some similarities. In this review, we compare both documents, focusing on the aim, population, classification of sports, and the methodology of making recommendations. This review aims to assist practicing cardiologists in integrating the available published data and recommendations when counseling patients for sports participation.
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Affiliation(s)
- Kamel Shibbani
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA; University of California-San Diego, Rady Children's Hospital, Department of Pediatrics, San Diego, California, USA.
| | - Ali Abdulkarim
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals, and Department of Cardiovascular Sciences, Catholic University, Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; ERN-GUARD HEART (European Reference Network)
| | - Jan Müller
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
| | - Keri Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Prashob Porayette
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Ali Zaidi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacqueline Kreutzer
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Mao Y, Wen Y, Liu B, Sun F, Zhu Y, Wang J, Zhang R, Yu Z, Chu L, Zhou A. Flexible wearable intelligent sensing system for wheelchair sports monitoring. iScience 2023; 26:108126. [PMID: 37915601 PMCID: PMC10616312 DOI: 10.1016/j.isci.2023.108126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/17/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023] Open
Abstract
The application of wearable intelligent systems toward human-computer interaction has received widespread attention. It is still desirable to conveniently promote health and monitor sports skills for disabled people. Here, a wireless intelligent sensing system (WISS) has been developed, which includes two ports of wearable flexible triboelectric nanogenerator (WF-TENG) sensing and an upper computer digital signal receiving intelligent processing. The WF-TENG sensing port is connected by the WF-TENG sensor and flexible printed circuit (FPC). Due to its flexibility, the WF-TENG sensing port can be freely adhered on the surface of human skin. The WISS can be applied to entertainment reaction training based on human-computer interaction, and to the technical judgment and analysis on wheelchair curling sport. This work provides new application opportunities for wearable devices in the fields of sports skills monitoring, sports assistive devices and health promotion for disabled people.
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Affiliation(s)
- Yupeng Mao
- School of Strength and Conditioning Training, Beijing Sport University, Beijing 100084, China
- Physical Education Department, Northeastern University, Shenyang 110819, China
| | - Yuzhang Wen
- Physical Education Department, Northeastern University, Shenyang 110819, China
| | - Bing Liu
- School of Martial Arts and Dance, Shenyang Sport University, Shenyang 110102, China
| | - Fengxin Sun
- Physical Education Department, Northeastern University, Shenyang 110819, China
| | - Yongsheng Zhu
- Physical Education Department, Northeastern University, Shenyang 110819, China
| | - Junxiao Wang
- School of Strength and Conditioning Training, Beijing Sport University, Beijing 100084, China
| | - Rui Zhang
- School of Strength and Conditioning Training, Beijing Sport University, Beijing 100084, China
| | - Zuojun Yu
- China Ice Sports College, Beijing Sport University, Beijing 100084, China
| | - Liang Chu
- Institute of Carbon Neutrality and New Energy & School of Electronics and Information, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Aiguo Zhou
- School of Strength and Conditioning Training, Beijing Sport University, Beijing 100084, China
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Scheffers LE, Helbing WA, Pereira T, Walet S, Utens EMWJ, Dulfer K, van den Berg LE. A 12-week lifestyle intervention: effects on fatigue, fear, and nutritional status in children with a Fontan circulation. Front Pediatr 2023; 11:1154015. [PMID: 38027302 PMCID: PMC10657862 DOI: 10.3389/fped.2023.1154015] [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: 01/30/2023] [Accepted: 07/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Children and adolescents with a Fontan circulation are less physically active compared to healthy peers. In the current study, effects of a 12-week lifestyle intervention on fatigue, fears regarding exercise, caloric intake, rest energy expenditure (REE), and body composition were measured in children with a Fontan circulation. Methods This study was a semi-cross-over randomized controlled trial. The lifestyle intervention consisted of a 12-week high-weight resistance training (three supervised training sessions a week) supported by high-protein diet (>2 g/kg) and tailored recommended caloric intake. Fatigue (measured by the validated PedsQol Multidimensional Fatigue Scale), fears regarding exercise (measured on a fear thermometer), REE (measured using indirect calorimetry), caloric intake and body composition using air displacement plethysmography, and four-skinfold method were measured before and after the intervention and control period. Results Twenty-seven pediatric Fontan patients, median age 12.9 years (IQR: 10.5-16.2), of the included 28 patients successfully completed the program. Before training, both child- and parent-reported levels of fatigue were significantly worse on all domains (general, sleep/rest, and cognitive fatigue) compared to healthy peers. After training, parent-reported fatigue significantly improved on the general and cognitive fatigue domains [effect size +16 points (7-25), p < 0.001, and +10 points (2-17), p = 0.015, compared to the control period]. Before training, fear regarding exercise scored on the fear thermometer was low for both children and parents (median score 1 and 2, respectively, on a scale of 0-8). After training, child-reported fear decreased further compared to the control period [effect size -1.4 points (-2.3 to -0.6), p = 0.001]. At baseline, children had increased REE +12% compared to reference values, which did not change after exercise. Children ate an average of 637 calories below recommended intake based on REE, caloric deficit became smaller after the intervention, and protein intake increased compared to the control period [-388 calories (-674 to -102), p = 0.008, and +15 g (0.4-30), p = 0.044]. Body fat percentage did not change significantly. Conclusion A 12-week lifestyle intervention improved parent-reported fatigue symptoms in the children, further decreased child-reported fears, and increased caloric and protein intake.
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Affiliation(s)
- L. E. Scheffers
- Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Paediatrics, Division of Gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
- Respiratory Medicine and Allergology, Department of Paediatrics, University Medical Center, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Paediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, Netherlands
| | - W. A. Helbing
- Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - T. Pereira
- Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - S. Walet
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - E. M. W. J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center/Levvel, Amsterdam, Netherlands
| | - K. Dulfer
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre Sophia Children’s Hospital, Rotterdam, Netherlands
| | - L. E. van den Berg
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, Netherlands
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Ma F, Li P, Zhang S, Shi W, Wang J, Ma Q, Zhao M, Nie Z, Xiao H, Chen X, Xie X. Decreased lipid levels in adult with congenital heart disease: a systematic review and Meta-analysis. BMC Cardiovasc Disord 2023; 23:523. [PMID: 37891491 PMCID: PMC10612202 DOI: 10.1186/s12872-023-03455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Metabolic disorders were a health problem for many adults with congenital heart disease, however, the differences in metabolic syndrome-related metabolite levels in adults with congenital heart disease compared to the healthy population were unknown. METHODS We collected 18 studies reporting metabolic syndrome-associated metabolite levels in patients with congenital heart disease. Data from different studies were combined under a random-effects model using Cohen's d values. RESULTS The results found that the levels of total cholesterol (Cohen's d -0.68, 95% CI: -0.91 to -0.45), high-density lipoprotein cholesterol (Cohen's d -0.63, 95% CI: -0.89 to -0.37), and low-density lipoprotein cholesterol (Cohen's d -0.32, 95% CI: -0.54 to -0.10) were significantly lower in congenital heart disease patients compared with controls. Congenital heart disease patients also had a lower body mass index (Cohen's d -0.27, 95% CI: -0.42 to -0.12) compared with controls. On the contrary, congenital heart disease patients had higher levels of hemoglobin A1c (Cohen's d 0.93, 95% CI: 0.17 to 1.70) than controls. Meanwhile, there were no significant differences in triglyceride (Cohen's d 0.07, 95% CI: -0.09 to 0.23), blood glucose (Cohen's d -0.12, 95% CI: -0.94 to 0.70) levels, systolic (Cohen's d 0.07, 95% CI: -0.30 to 0.45) and diastolic blood pressure (Cohen's d -0.10, 95% CI: -0.39 to 0.19) between congenital heart disease patients and controls. CONCLUSIONS The lipid levels in patients with congenital heart disease were significantly lower than those in the control group. These data will help in the health management of patients with congenital heart disease and guide clinicians. PROSPERO REGISTRATION NUMBER CRD42022228156.
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Affiliation(s)
- Fengdie Ma
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Peiqiang Li
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
| | - Shasha Zhang
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wenjing Shi
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Jing Wang
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Qinglong Ma
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Meie Zhao
- The first people's hospital of Lanzhou city, Lanzhou, Gansu, China
| | - Ziyan Nie
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Handan Xiao
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Xinyi Chen
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaodong Xie
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
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Amiri M, Li J, Hasan W. Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study. JMIR Form Res 2023; 7:e46434. [PMID: 37535413 PMCID: PMC10436119 DOI: 10.2196/46434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/07/2023] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Chronic diseases such as heart disease, stroke, diabetes, and hypertension are major global health challenges. Healthy eating can help people with chronic diseases manage their condition and prevent complications. However, making healthy meal plans is not easy, as it requires the consideration of various factors such as health concerns, nutritional requirements, tastes, economic status, and time limits. Therefore, there is a need for effective, affordable, and personalized meal planning that can assist people in choosing food that suits their individual needs and preferences. OBJECTIVE This study aimed to design an artificial intelligence (AI)-powered meal planner that can generate personalized healthy meal plans based on the user's specific health conditions, personal preferences, and status. METHODS We proposed a system that integrates semantic reasoning, fuzzy logic, heuristic search, and multicriteria analysis to produce flexible, optimized meal plans based on the user's health concerns, nutrition needs, as well as food restrictions or constraints, along with other personal preferences. Specifically, we constructed an ontology-based knowledge base to model knowledge about food and nutrition. We defined semantic rules to represent dietary guidelines for different health concerns and built a fuzzy membership of food nutrition based on the experience of experts to handle vague and uncertain nutritional data. We applied a semantic rule-based filtering mechanism to filter out food that violate mandatory health guidelines and constraints, such as allergies and religion. We designed a novel, heuristic search method that identifies the best meals among several candidates and evaluates them based on their fuzzy nutritional score. To select nutritious meals that also satisfy the user's other preferences, we proposed a multicriteria decision-making approach. RESULTS We implemented a mobile app prototype system and evaluated its effectiveness through a use case study and user study. The results showed that the system generated healthy and personalized meal plans that considered the user's health concerns, optimized nutrition values, respected dietary restrictions and constraints, and met the user's preferences. The users were generally satisfied with the system and its features. CONCLUSIONS We designed an AI-powered meal planner that helps people create healthy and personalized meal plans based on their health conditions, preferences, and status. Our system uses multiple techniques to create optimized meal plans that consider multiple factors that affect food choice. Our evaluation tests confirmed the usability and feasibility of the proposed system. However, some limitations such as the lack of dynamic and real-time updates should be addressed in future studies. This study contributes to the development of AI-powered personalized meal planning systems that can support people's health and nutrition goals.
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Affiliation(s)
- Maryam Amiri
- Department of Computer Science, North Dakota State University, Fargo, ND, United States
| | - Juan Li
- Department of Computer Science, North Dakota State University, Fargo, ND, United States
| | - Wordh Hasan
- Department of Computer Science, North Dakota State University, Fargo, ND, United States
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Mansfield LK, Reichman JR, Crowley DI, Flyer JN, Freeman K, Gauvreau KK, Mackie SA, Marino BS, Newburger JW, Ziniel SI, Brown DW. Living with Congenital Aortic Stenosis: Exercise Restriction, Patterns of Adherence, and Quality of Life. Pediatr Cardiol 2023:10.1007/s00246-023-03165-2. [PMID: 37344559 DOI: 10.1007/s00246-023-03165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/16/2023] [Indexed: 06/23/2023]
Abstract
Modern consensus panel guidelines recommend restriction from most organized sports for patients with moderate or severe aortic stenosis (AS). However, there is little published data on how frequently physicians deviate from guidelines, how well patients adhere to exercise restrictions, or the effect of restriction on patient-reported quality of life. In this study, we surveyed 93 subjects with AS and their cardiologists regarding participation in organized sports, physical activity, weightlifting, and exercise restriction. Subjects completed the pediatric quality of life inventory (PedsQL) and the pediatric cardiac quality of life inventory (PCQLI). We found that subjects with severe AS (n = 3) were commonly, but not universally, restricted from organized sports (n = 2, 66%). Subjects with moderate AS (n = 40) were rarely restricted from organized sports (n = 6, 17%). No physician-specific characteristics were associated with increased likelihood of recommending exercise restriction. Subjects were more likely to be restricted if they were older (16 years vs. 13 years, p 0.02) and had moderate versus mild AS (p 0.013). PCQLI scores for teens and young adults with AS (age 13-25) were lower than a comparison group of patients with mild congenital heart disease. For all age groups, the PedsQL social functioning score was lower for subjects with exercise restriction (p 0.052). In summary, cardiologists apply consensus guidelines leniently when restricting patients with moderate/severe AS from organized sports and weightlifting. Patients with AS routinely adhere to exercise restriction recommendations. Children and young adults with AS and exercise restriction have lower QOL scores in the social functioning domain.
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Affiliation(s)
- Laura K Mansfield
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Jeffrey R Reichman
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - David I Crowley
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jonathan N Flyer
- Division of Pediatric Cardiology, Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Kaitlyn Freeman
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kimberlee K Gauvreau
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Stewart A Mackie
- Division of Pediatric Cardiology Department of Pediatrics and Medical Social Sciences Department of PediatricsBaystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA
| | - Bradley S Marino
- Divisions of Cardiology and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jane W Newburger
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Sonja I Ziniel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - David W Brown
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
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Jordan CAL, Alizadeh F, Ramirez LS, Kimbro R, Lopez KN. Obesity in Pediatric Congenital Heart Disease: The Role of Age, Complexity, and Sociodemographics. Pediatr Cardiol 2023:10.1007/s00246-023-03148-3. [PMID: 36964218 DOI: 10.1007/s00246-023-03148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/11/2023] [Indexed: 03/26/2023]
Abstract
The prevalence of obesity in children with congenital heart disease (CHD) is greater than 25%, putting these patients at-risk for increased surgical morbidity and mortality. Our goal was to determine the association between CHD complexity, sociodemographic factors, and obesity. Our hypothesis was that among CHD patients, the odds of obesity would be highest in older children with simple CHD, and in all children with a lower socioeconomic status. We conducted a retrospective cohort study, reviewing electronic medical records of children aged 2-17 years from over 50 outpatient pediatric clinics in Houston, TX. Children were classified as simple or moderate/complex CHD, and obesity was defined by BMI ≥ 95th percentile for age and sex. Logistic regression was used to determine the association between sociodemographic factors and CHD complexity with obesity. We identified 648 CHD and 369,776 non-CHD patients. Children with simple CHD had a similar odds of obesity as non-CHD children. Children with CHD had a higher prevalence of obesity if they were older, male, Black, Hispanic, and publicly insured. Children with moderate/complex CHD had lower odds of obesity [OR 0.24 (95% CI 0.07-0.73)], however their predicted probability of obesity approached that of the general population as they aged. Additionally, there was an incremental relationship with poverty and obesity [1.01 (1.01-1.01)]. Awareness of which patients with CHD are at highest risk of obesity may help in targeting interventions to assist at-risk patients maintain a healthy lifestyle.
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Affiliation(s)
| | - Faraz Alizadeh
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Keila Natilde Lopez
- Texas Children's Hospital, Houston, TX, USA.
- Baylor College of Medicine, Houston, TX, USA.
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8
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Prescription medication use after congenital heart surgery. Cardiol Young 2022; 32:1786-1793. [PMID: 34986916 DOI: 10.1017/s1047951121005060] [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: 11/06/2022]
Abstract
BACKGROUND Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. METHODS Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. RESULTS Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7-2.1; severe hazard ratio 6.5, 95% confidence interval 5.3-8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8-3.7; severe hazard ratio 38.8, 95% CI 27.5-54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. CONCLUSIONS The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.
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Lambert LM, Pemberton VL, Trachtenberg FL, Uzark K, Woodard F, Teng JE, Bainton J, Clarke S, Justice L, Meador MR, Riggins J, Suhre M, Sylvester D, Butler S, Miller TA. Design and methods for the training in exercise activities and motion for growth (TEAM 4 growth) trial: A randomized controlled trial. Int J Cardiol 2022; 359:28-34. [PMID: 35447274 DOI: 10.1016/j.ijcard.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Growth is often impaired in infants with congenital heart disease. Poor growth has been associated with worse neurodevelopment, abnormal behavioral state, and longer time to hospital discharge. Nutritional interventions, drug therapy, and surgical palliation have varying degrees of success enhancing growth. Passive range of motion (PROM) improves somatic growth in preterm infants and is safe and feasible in infants with hypoplastic left heart syndrome (HLHS), after their first palliative surgery (Norwood procedure). METHODS This multicenter, Phase III randomized control trial of a 21-day PROM exercise or standard of care evaluates growth in infants with HLHS after the Norwood procedure. Growth (weight-, height- and head circumference-for-age z-scores) will be compared at 4 months of age or at the pre-superior cavopulmonary connection evaluation visit, whichever comes first. Secondary outcomes include neonatal neurobehavioral patterns, neurodevelopmental assessment, and bone mineral density. Eligibility include diagnosis of HLHS or other single right ventricle anomaly, birth at ≥37 weeks gestation and Norwood procedure at <30 days of age, and family consent. Infants with known chromosomal or recognizable phenotypic syndromes associated with growth failure, listed for transplant, or expected to be discharged within 14 days of screening are excluded. CONCLUSIONS The TEAM 4 Growth trial will make an important contribution to understanding the role of PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with complex cardiac anomalies, who are at high risk for growth failure and developmental concerns.
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Affiliation(s)
- Linda M Lambert
- Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States of America.
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, United States of America
| | | | - Karen Uzark
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, United States of America
| | - Frances Woodard
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jessica E Teng
- HealthCore Inc., Watertown, MA, United States of America
| | - Jessica Bainton
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shanelle Clarke
- Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Lindsey Justice
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Marcie R Meador
- Division of Cardiology Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States of America
| | - Jessica Riggins
- Division of Cardiovascular Surgery, Riley Hospital for Children at IU Health, Indianapolis, IN, United States of America
| | - Mary Suhre
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Donna Sylvester
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Samantha Butler
- Department of Psychiatry, Children's Hospital Boston, Boston, MA, United States of America
| | - Thomas A Miller
- Division of Cardiology, Maine Medical Center, Portland, ME, United States of America
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10
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The impact of the COVID-19 pandemic on application of European Society of Cardiology (ESC) guidelines for exercise in adults with CHD: a data-based questionnaire. Cardiol Young 2022; 32:270-275. [PMID: 33902783 PMCID: PMC8129687 DOI: 10.1017/s1047951121001864] [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: 12/23/2022]
Abstract
INTRODUCTION Regular physical activity is safe and effective therapy for adults with CHD and is recommended by European Society of Cardiology guidelines. The COVID-19 pandemic poses enormous challenges to healthcare teams and patients when ensuring guideline compliance. We explored the implications of COVID-19 on physical activity levels in adult CHD patients. MATERIALS AND METHODS A data-based questionnaire was distributed to adult CHD patients at a regional tertiary centre from October to November 2020. RESULTS Prior to the COVID-19 pandemic, 96 (79.3%) of 125 respondents reported participating in regular physical activity, with 66 (52.8%) meeting target levels (moderate physical activity for at least 150 minutes per week). Commonest motivations for physical activity were general fitness (53.6%), weight loss (36.0%), and mental health benefits (30.4%). During the pandemic, the proportion that met target levels significantly decreased from 52.8% to 40.8% (p = 0.03). The commonest reason was fear of COVID-19 (28.0%), followed by loss of motivation (23.2%) and gym/fitness centre closure (15.2%). DISCUSSION The COVID-19 pandemic has negatively impacted exercise levels of adult CHD patients. Most do not meet recommended physical activity levels, mainly attributable to fear of COVID-19. Even before the pandemic, only half of respondents met physical activity guidelines. Availability of online classes can positively impact exercise levels so could enhance guideline compliance. This insight into health perceptions and behaviours of adult CHD patients may help develop quality improvement initiatives to improve physical activity levels in this population.
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Abstract
INTRODUCTION With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed during a clinical review. METHODS A retrospective observational cohort study was completed using a cardiology outpatient dataset from 2010 to 2019. Inclusion criteria are all children with a body mass index z score classified as obese (≥ 2 z scores). Individual electronic patient records were reviewed to identify long-term anthropometric measures including (i) recognition of body habitus, (ii) prescription of physical activity or dietary intervention, and (iii) referral to a weight management programme or dietitian. RESULTS From the cohort of 95 patients, 285 "obese clinical encounters" were identified, at the time of a cardiology clinic attendance. Of those, obesity was acknowledged in 25 clinic letters (8.65%), but only 8 used the correct terms "obese" or "obesity" (2.77%). Action to tackle obesity was recorded in 9.3% of cases with a direct referral to a dietitian being made on 3 occasions (1.04%). CONCLUSIONS Body habitus is not being routinely addressed by cardiologists caring for paediatric and young adult cardiac patients. This study has recognised an alarmingly high incidence of missed opportunities to make every contact count, to manage those with obesity and associated risk factors.
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Evans C, Curtis S, Bedair R, Turner M, Szantho G, Stuart AG. A feasibility pilot- a personalised physiotherapy led remote ACHD cardiac rehabilitation program. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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The Effects of Physical Inactivity and Exercise at Home in Young Patients with Congenital Heart Disease during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910065. [PMID: 34639368 PMCID: PMC8507665 DOI: 10.3390/ijerph181910065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
Background: The COVID-19 pandemic had a significant impact on the population’s ability to be physically active. Purpose: Evaluate the effect of the COVID-19 mitigation measures on exercise tolerance in patients with congenital heart disease (CHD). Materials and methods: All subjects (880, 6–18 years old) who performed a stress test at our hospital from October 2020 to February 2021 and had a similar test one year earlier were enrolled. A questionnaire on the degree of physical activity carried out in 2020 concerning the period prior to the pandemic was compiled. Exercise tolerance and the main anthropometric parameters between the first and second tests were compared. Results: 110 subjects (11.9 ± 4.1 years) were included in the study. The percentage of patients engaged in regular physical activity (RPA) decreased significantly during the pandemic (p < 0.001), and BMI increased significantly (p < 0.001), except among the subjects who began RPA during the lockdown, whereas test duration did not decrease significantly overall but increased in this last subgroup (p < 0.05) Conclusions: The COVID-19 lockdown led to a less active lifestyle with a significant increase in BMI in our group of CHD. These data could have negative effects on the risk profile of this population. RPA practiced at home seems to be effective in counteracting such effects.
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Inactive Lifestyles among Young Children with Innocent Murmurs or Congenital Heart Disease Regardless of Disease Severity or Treatment. Can J Cardiol 2021; 38:59-67. [PMID: 34555459 DOI: 10.1016/j.cjca.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sedentary lifestyle morbidities are common among children with congenital heart disease (CHD). Understanding the physical activity trajectory from early childhood could enhance intervention timing/effectiveness. METHODS 154 children (56% male) were recruited at 12-47 months of age for this prospective, longitudinal, observational study. Physical activity and sedentary behaviour (7-day accelerometry) and motor skill (Peabody Developmental Motor Scales-2) were assessed every 8 months until 5 years of age and then annually. Mixed effect repeated measures regression models described outcome trajectories across study assessments. RESULTS Children had an innocent heart murmur (n=28), CHD with insignificant hemodynamics not requiring treatment (n=47), CHD treated by catheterization or surgery without cardiopulmonary bypass (n=31), or CHD treated surgically with bypass (n=48). Motor skill was age appropriate (Peabody 49.0±8.4) but participants had lower physical activity (143±41 mins/day) and higher sedentary time (598±89 mins/day) than healthy peers, starting at 18 months of age. Movement behaviours were not related to treatment group (p>0.10), and physical activity was below the recommended 180 mins/day. Over time, physical activity, sedentary time and motor skill were primarily related to the baseline measure of each outcome (p<0.001). CONCLUSIONS Children with simple or complex CHD or innocent heart murmurs have an increased risk for sedentary lifestyles. Their physical activity and sedentary behaviours are established prior to 2 years of age, persist until school age, and are unrelated to motor skill. These results emphasize the need for interventions targeting the youngest children seen in a cardiac clinic, regardless of CHD diagnosis or innocent murmur.
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Byrne RD, Weingarten AJ, Clark DE, Healan SJ, Richardson TL, Huang S, Menachem JN, Frischhertz BP. Sizing Up Fontan Failure: Association with Increasing Weight in Adulthood. Pediatr Cardiol 2021; 42:1425-1432. [PMID: 33948709 DOI: 10.1007/s00246-021-02628-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
Obesity has become increasingly recognized in adults with Fontan palliation, yet the relationship between weight changes in adulthood and Fontan failure is not clearly defined. We hypothesize that increasing weight in adulthood among Fontan patients is associated with the development of Fontan failure. Single-center data from adults with Fontan palliation who were not in Fontan failure at their first clinic visit in adulthood and who received ongoing care were retrospectively collected. Fontan failure was defined as death, transplant, diagnosis of protein losing enteropathy, predicted peak VO2 less than 50%, or new loop diuretic requirement. Anthropometric data including weight and BMI were collected. Change in weight was compared between those that developed Fontan failure, and those that remained failure-free. To estimate the association between weight change during adulthood and the risk of developing Fontan failure, a survival analysis using multiple Cox's proportional hazards regression model was performed. Overall, 104 patients were included in the analysis. Those that developed Fontan failure had a larger associated median weight gain than those who remained failure-free (7.8 kg vs. 4.9 kg, respectively; p = 0.011). In multivariable Cox regression analysis, increased weight during adulthood was associated with increased likelihood of developing Fontan failure (HR 1.36; CI 1.07-1.73; p = 0.011). Weight gain in adulthood is associated with the development of Fontan failure.
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Affiliation(s)
- Ryan D Byrne
- Department of Pediatrics, Section of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Legacy Tower, 6651 Main St, Houston, TX, 77030, USA.
| | - Angela J Weingarten
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Pediatric Heart Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel E Clark
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven J Healan
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tadarro L Richardson
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan N Menachem
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin P Frischhertz
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Pediatric Heart Institute, Vanderbilt University Medical Center, Nashville, TN, USA
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Haregu F, McDaniel G, Dean P. Exercise and Sports Participation in Adolescents and Young Adults With Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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American College of Cardiology Body Mass Index Counseling Quality Improvement Initiative. Pediatr Cardiol 2021; 42:1190-1199. [PMID: 33856499 DOI: 10.1007/s00246-021-02600-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
Overweight/obesity, prevalent cardiovascular risk factors in children, can be associated with increased risk of adverse outcomes in children with heart disease. The American College of Cardiology (ACC) developed quality metrics including a BMI metric related to identifying and counseling overweight and obese children presenting to cardiology clinics. This metric was used for a multicenter collaborative learning Quality improvement (QI) Project through the ACC Quality Network (QNet). Our aim was to increase the percentage of children between ages 3 and 18 years presenting to cardiology clinics at participating centers with BMI > 85th percentile who received appropriate counseling. Participating centers submitted data quarterly to QNet for a sample of patients who received counseling. A Key Driver Diagram was created to help teams drive improvement. Individual centers customized interventions and participated in network-wide educational learning sessions about QI and shared experience. Statistical process control charts were used. From 04/01/2017 to 09/30/2019, 27,511 patient visits were included. Among 32 participating centers, overall counseling rate was 54%. The BMI counseling rate increased from 25% in 2017Q2 to 54% in 2019Q3. There was a wide variation from 10 to 100% in the performance of individual centers. The overall rate of identification and counseling of overweight and obese children presenting to ambulatory cardiology clinics in participating centers is low. There is wide variation in the performance of centers, providing an opportunity for improvement. Using this multicenter learning approach, individual centers have demonstrated improvement. This demonstrates that collaborative learning approaches in QI can increase implementation of the metric.
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Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:563-576. [PMID: 33968634 DOI: 10.21037/cdt-20-781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In adults with congenital heart disease (ACHD), conditions acquired with aging, such as metabolic syndrome, hypertension, diabetes mellitus, and obesity, can negatively influence the original cardiovascular disease. Metabolic syndrome has a higher prevalence in ACHD than in the general population. In contrast, coronary artery disease shows a similar prevalence in adults with acyanotic CHD and the general population, while adults with cyanotic CHD, even after repair, have an even lower incidence of coronary artery disease than the general population/adults with acyanotic CHD. However, even in those with cyanotic CHD, coronary artery disease can develop when they have risk factors such as obesity, dyslipidemia, hypertension, diabetes mellitus, smoking habit, or limited exercise. The prevalence of risk factors for cardiovascular disease is similar between ACHD and the general population, but an increased risk of coronary atherosclerosis has been observed for congenital coronary artery anomalies, dextro-transposition of the great arteries after arterial switch operation, Ross procedure, and coarctation of the aorta. Aortopathy may be an additional risk factor for cardiovascular disease. As ACHD have other abnormalities that may make the heart more vulnerable to both the development of atherosclerosis and adverse cardiovascular sequelae, regular evaluation of their cardiovascular disease risk status is recommended. Metabolic syndrome is more common among ACHD than in the general population, and may therefore increase the future incidence of atherosclerotic coronary artery disease even in ACHD. Thus, ACHD should be screened for metabolic syndrome to eliminate risk factors for atherosclerotic coronary artery disease.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo 104-8560, Japan
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Perceptions of Healthy Lifestyles Among Children With Complex Heart Disease and Their Caregivers. CJC Open 2021; 3:854-863. [PMID: 34401692 PMCID: PMC8347848 DOI: 10.1016/j.cjco.2021.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Children with complex heart problems may be at higher risk for sedentary lifestyle morbidities than their healthy peers. This project examined perceptions, barriers, and supports that influence healthy active lifestyles among children with complex heart problems and their caregivers, to enable effective health and quality-of-life interventions. Methods Inductive thematic analysis was conducted of semi-structured guided discussions from 6 focus groups (young child [n = 2]; older child [n = 4]; parents of young child [n = 4]; parents of older child [n = 4]; pediatric cardiologist [n = 5]; pediatric cardiac nurse [n = 5]) and individual interviews with 7 parents, 5 parent/child dyads, 2 adults with complex heart problems, 6 pediatric cardiologists, 3 pediatric cardiac nurses, 4 pediatric cardiology mental health professionals, and 14 recreation professionals. Results Four interrelated themes were identified: (i) "It takes a village"—coordinated and collaborative interdisciplinary support; (ii) clear healthy lifestyle communication among children, families, and professionals is critically important; (iii) Ccreating supportive environments by building professional expertise; (iv) inspiring healthy lifestyles in the children’s own environments. All groups identified a need to improve knowledge about childhood heart conditions among education and recreation professionals and to encourage effective communication between healthcare professionals and families. Participants indicated that these changes would support families, educators, and recreation professionals in engaging children with heart problems in healthy lifestyles in home, school, and community settings. Conclusions Important healthy lifestyle barriers were identified within individuals and in their interactions. There is a profound need to enhance knowledge of childhood heart conditions and improve interactions among key stakeholders—children and families, educators, and recreation and healthcare professionals.
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Berger JH, Chen F, Faerber JA, O'Byrne ML, Brothers JA. Adherence with lipid screening guidelines in standard- and high-risk children and adolescents. Am Heart J 2021; 232:39-46. [PMID: 33229294 PMCID: PMC7854880 DOI: 10.1016/j.ahj.2020.10.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Because atherosclerosis begins in childhood, universal lipid screening is recommended with special attention to conditions predisposing to early atherosclerosis. Data about real-world penetration of these guidelines is not available. METHODS Retrospective cohort study using MarketScan® commercial and Medicaid insurance claims databases, a geographically representative sample of U.S. children. Subjects who passed through the 9- to 11-year window and had continuous insurance coverage between 1/1/2013 and 12/31/2016 were studied. Multivariable models were calculated, evaluating the association between other patient factors and the likelihood of screening. The primary hypothesis was that screening rates would be low, but that high-risk conditions would be associated with a higher likelihood of screening. RESULTS In total, 572,522 children (51% male, 33% black, 11% Hispanic, 51% Medicaid) were studied. The prevalence of high-risk conditions was 2.2%. In unadjusted and adjusted analyses, these subjects were more likely to be screened than standard-risk subjects (47% vs. 20%, OR: 3.7, 95% CI 3.5-3.8, P < .001). Within this group, the diagnosis-specific likelihood of screening varied (26-69%). Endocrinopathies (OR 5.4, 95% CI 5.2-5.7), solid organ transplants (OR 5.0, 95% CI 3.8-6.6), and metabolic disease (OR 3.9, 95% CI 3.1-5.0, all P < .001) were associated with the highest likelihood of undergoing screening. CONCLUSIONS Despite national recommendations, lipid screening was performed in a minority of children. Though subjects with high-risk conditions had a higher likelihood of screening, rates remained low. This study highlights the need for research and advocacy regarding obstacles to lipid screening of children in the United States.
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Affiliation(s)
- Justin H Berger
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Feiyan Chen
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jennifer A Faerber
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute for Health Economics and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA
| | - Julie A Brothers
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Jackson JL, Fox KR, Cotto J, Harrison TM, Tran AH, Keim SA. Obesity across the lifespan in congenital heart disease survivors: Prevalence and correlates. Heart Lung 2020; 49:788-794. [PMID: 32980629 DOI: 10.1016/j.hrtlng.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) survivors are at risk for cardiovascular comorbidities exacerbated by obesity. OBJECTIVES Determine relationships between overweight/obesity and medical factors across the lifespan of CHD. METHODS Lesion severity, weight, blood pressure, cardiac and other comorbidities, and cardiac medications were abstracted from the medical records of 3790 CHD patients, aged ≥6 years, who attended CHD care in the Midwestern U.S. RESULTS The proportion of patients with overweight/obesity increased across the lifespan, with 73% of adults affected by overweight/obesity. Obesity was more prevalent among patients with moderate lesions (29%). Overweight/obesity was associated with elevated blood pressure across age and lesion severity. Young adults with obesity and simple or moderate lesions had more comorbidities (simple: IRR = 3.1, moderate: IRR = 2.3) and cardiac medications (simple: IRR = 2.2, moderate: IRR = 1.7). CONCLUSIONS Obesity and its cardiovascular correlates are present across the lifespan for CHD survivors, highlighting the need for early prevention and intervention.
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Affiliation(s)
- Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA.
| | - Kristen R Fox
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA.
| | - Jennifer Cotto
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA
| | - Tondi M Harrison
- College of Nursing, The Ohio State University, 1585 Neil Ave., Columbus, OH 43210, USA.
| | - Andrew H Tran
- Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA; The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA.
| | - Sarah A Keim
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA; Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave, Columbus, OH 43210, USA.
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Polyviou S, Frigiola A, Charakida M. Physical activity assessment and advice as part of routine clinical care in patients with congenital heart disease. Hellenic J Cardiol 2020; 61:187-189. [PMID: 32916293 DOI: 10.1016/j.hjc.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Stavros Polyviou
- Pediatric Cardiology Department, Evelina Children's Hospital, NHS Trust, UK
| | - Alessandra Frigiola
- Adult Congenital Heart Disease Department, St Thomas' Hospital, NHS Trust, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Marietta Charakida
- Pediatric Cardiology Department, Evelina Children's Hospital, NHS Trust, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, UK.
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Blais AZ, Lougheed J, Yaraskavitch J, Adamo KB, Longmuir PE. "I really like playing games together": Understanding what influences children with congenital heart disease to participate in physical activity. Child Care Health Dev 2020; 46:457-467. [PMID: 32011750 DOI: 10.1111/cch.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/17/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Participation in physical activity is essential to the long-term health and development of all children. However, children living with cardiac conditions are typically not active enough to sustain positive health outcomes. Understanding the experiences of children living with congenital heart disease in community-based settings could help inform the physical activity counselling practices of clinicians. The current study explored the perceptions of 7- to 10-year-old children with moderate or complex congenital heart disease as they participated in a 10-week multisport programme. METHODS Detailed field notes recorded the discussions and behaviours of 11 participants (45% female participants) each week during the programme sessions. Among those, four participants (50% female participants) were purposively selected to participate in preprogramme and postprogramme focus groups to gather more detailed accounts of their experiences. RESULTS Four main themes surrounding physical activity were identified: (a) motivation, (b) self-efficacy, (c) peer influences, and (d) family influences. Although feelings of excitement and enjoyment towards physical activity were prevalent throughout the data ("I'm really excited … because I really like those sports"), participants also often felt frustrated, nervous, and fatigued ("I'm not very good at the skills"). Social inclusion with peers and family influences were meaningful reasons to engage in physical activity ("I really like playing games together"). Following the completion of the programme, participants emphasized their enjoyment of physical activity as a primary source of motivation, demonstrating an important shift from recognizing positive health outcomes ( "… it's good for you") towards more intrinsic sources of motivation ("… because it's fun"). CONCLUSION Opportunities for physical activity that enhance positive experiences and build intrinsic motivation should be identified and promoted to children with congenital heart disease. Community-based programmes may also be an appropriate context for children with cardiac conditions to engage and maintain participation in physical activity through adolescence.
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Affiliation(s)
- Angelica Z Blais
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jane Lougheed
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jenna Yaraskavitch
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Patricia E Longmuir
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Honicky M, Cardoso SM, de Lima LRA, Ozcariz SGI, Vieira FGK, de Carlos Back I, Moreno YMF. Added sugar and trans fatty acid intake and sedentary behavior were associated with excess total-body and central adiposity in children and adolescents with congenital heart disease. Pediatr Obes 2020; 15:e12623. [PMID: 32050058 DOI: 10.1111/ijpo.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/07/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past three decades, the prevalence rate of overweight and obesity has increased in survivors with congenital heart disease, and little is known about the body composition and its association with clinical characteristics and lifestyle factors. OBJECTIVES To evaluate excess total-body adiposity and central adiposity and, to describe associated factors. METHODS Cross-sectional study with children and adolescents who underwent procedure to treat congenital heart disease, from January to July 2017. Sociodemographic and clinical characteristics, and lifestyle factors (dietary intake, physical activity, and sedentary behavior) were assessed. Adiposity was assessed using air-displacement plethysmography and waist circumference. Factors associated with excess total-body adiposity and central adiposity were analyzed using logistic regression models. RESULTS Of 232 patients, 22.4% were identified with excess total-body adiposity and 24.6% with central adiposity. Significant factors positively associated with excess total-body adiposity were intake of added sugar and trans fatty acids, adjusted for confounding factors. Similarly, lifestyle factors were positively associated with central adiposity: intake of added sugar and trans fatty acids, sedentary behavior, and family history of obesity. CONCLUSIONS Lifestyle factors were associated with excess total-body adiposity and central adiposity. Assessment of body composition and healthy-lifestyle counseling into outpatient care may be the key point to prevent obesity in children and adolescents with congenital heart disease.
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Affiliation(s)
- M Honicky
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - S M Cardoso
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - L R A de Lima
- Department of Physical Education, University of State Santa Catarina, Laguna, South Carolina, Brazil
| | - S G I Ozcariz
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - F G K Vieira
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - I de Carlos Back
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - Y M F Moreno
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
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Recommendations for exercise in adolescents and adults with congenital heart disease. Prog Cardiovasc Dis 2020; 63:350-366. [DOI: 10.1016/j.pcad.2020.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/17/2022]
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Raissadati A, Haukka J, Pätilä T, Nieminen H, Jokinen E. Chronic Disease Burden After Congenital Heart Surgery: A 47-Year Population-Based Study With 99% Follow-Up. J Am Heart Assoc 2020; 9:e015354. [PMID: 32316818 PMCID: PMC7428561 DOI: 10.1161/jaha.119.015354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Postoperative morbidity is an increasingly important outcome measure of patients who have undergone congenital heart surgery (CHS). We examined late postoperative morbidity after CHS on the basis of patients' government-issued medical special reimbursement rights. Methods and Results Between 1953 and 2009, 10 635 patients underwent CHS at <15 years of age in Finland. We excluded early deaths and mental disabilities. Noncyanotic and cyanotic defects were divided into simple and severe groups, respectively. We obtained 4 age-, sex-, birth time-, and hospital district-matched control subjects per patient. The Social Insurance Institution of Finland provided data on all medical special reimbursement rights granted between 1966 and 2012. Follow-up started at the first operation and ended at death, date of emigration, or December 31, 2012. A total of 8623 patients met inclusion criteria. Follow-up was 99.9%. A total of 3750 patients (43%) required special reimbursements rights for a chronic disease. Cardiovascular disease was the most common late morbidity among patients (28%), followed by obstructive pulmonary disease (9%), neurologic disease (3%), and psychiatric disease (2%). Heart failure (simple hazard ratio [HR], 56.3 [95% CI, 35.4-89.7]; severe HR, 918.0 [95% CI, 228.9-3681.7]) and arrhythmia (simple HR, 11.0 [95% CI, 7.1-17.0]; severe HR, 248.0 [95% CI, 61.3-1002.7]) were the most common cardiovascular morbidities. Hypertension was common among patients with coarctation of the aorta (13%; incidence risk ratio [RR], 8.9; 95% CI, 7.5-10.7). Psychiatric disease was more common among simple defects, particularly ventricular septal defects. Conclusions Chronic cardiac and noncardiac sequelae are common after CHS regardless of the severity of the defect, underscoring the importance of long-term follow-up of all patients after CHS.
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Affiliation(s)
- Alireza Raissadati
- Department of Surgery and Cardiology New Children's Hospital University of Helsinki and Helsinki University Central Hospital Helsinki Finland.,Boston Children's Hospital Boston MA
| | - Jari Haukka
- Department of Public Health Clinicum Faculty of Medicine University of Helsinki Finland.,Department of Health Sciences Faculty of Medicine and Health Technology University of Tampere Finland
| | - Tommi Pätilä
- Department of Surgery and Cardiology New Children's Hospital University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Heta Nieminen
- Department of Surgery and Cardiology New Children's Hospital University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Eero Jokinen
- Department of Surgery and Cardiology New Children's Hospital University of Helsinki and Helsinki University Central Hospital Helsinki Finland
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Lemire O, Yaraskavitch J, Lougheed J, Mackie AS, Norozi K, Graham J, Willan AR, Longmuir PE. Impacting child health outcomes in congenital heart disease: Cluster randomized controlled trial protocol of in-clinic physical activity counselling. Contemp Clin Trials 2020; 91:105994. [PMID: 32222326 DOI: 10.1016/j.cct.2020.105994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most (>90%) children with congenital health defects are not active enough for optimal health. Proactively promoting physical activity during every clinic visit is recommended, but rarely implemented due to a lack of appropriate resources. METHODS This cluster randomized controlled trial will implement an evidence-based, multi-faceted physical activity intervention. All eligible patients at small (London, ON), medium (Ottawa, ON) and large (Edmonton, AB) pediatric cardiac clinics will be approached, with randomization to intervention/control by clinic and week. Intervention patients will be counselled with 5 key physical activity messages, have questions about physical activity answered, and have access to a custom web site with personalized activity suggestions and support from a Registered Kinesiologist. The primary outcome is daily physical activity (number of steps, minutes of moderate-to-vigorous activity) assessed via pedometer one week per month for 6-months. Standardized questionnaires assess activity motivation and quality of life at baseline and end of study. Healthcare outcomes will be clinic visit time and contacts for physical activity concerns. Repeated measures ANCOVA will compare control/intervention pedometer outcomes, adjusting for covariates (alpha=0.05). CONCLUSIONS This trial aims to determine whether providing resources and protocols enables clinicians to counsel about physical activity as part of every pediatric cardiology appointment. Evaluations of healthcare system impact and intervention delivery in small, medium and large clinics will assess applicability for implementation in all pediatric cardiac clinics. The impact on physical activity motivation and participation will evaluate the effectiveness of this standardized approach for increasing physical activity in children with congenital heart defects.
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Affiliation(s)
- Olivia Lemire
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jenna Yaraskavitch
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Andrew S Mackie
- Stollery Children's Hospital, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Schulich School of Medicine and Dentistry, Western University & Children's Health Research Institute, London, Ontario, Canada; Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany
| | - Jennifer Graham
- Canadian Congenital Heart Alliance, Toronto, Ontario, Canada
| | | | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.
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Mohamed Ali H, Mustafa M, Suliman S, Elshazali OH, Ali RW, Berggreen E. Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect. Oral Dis 2020; 26:1053-1061. [DOI: 10.1111/odi.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/18/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Hiba Mohamed Ali
- Department of Clinical Dentistry Faculty of Medicine University of Bergen Bergen Norway
| | - Manal Mustafa
- Oral Health Centre of Expertise in Western Norway Bergen Norway
| | - Salwa Suliman
- Department of Clinical Dentistry Faculty of Medicine University of Bergen Bergen Norway
| | - Osama Hafiz Elshazali
- Faculty of Medicine University of Khartoum Ahmed Gasim Hospital Ministry of Health Khartoum Sudan
| | - Raouf Whahab Ali
- Department of Periodontics University of Science and Technology Khartoum Sudan
| | - Ellen Berggreen
- Oral Health Centre of Expertise in Western Norway Bergen Norway
- Department of Biomedicine Faculty of Medicine and Dentistry University of Bergen Bergen Norway
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29
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e637-e697. [PMID: 30586768 DOI: 10.1161/cir.0000000000000602] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
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30
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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Neurocognition in Adult Congenital Heart Disease: How to Monitor and Prevent Progressive Decline. Can J Cardiol 2019; 35:1675-1685. [DOI: 10.1016/j.cjca.2019.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
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Shustak RJ, Cohen MS. What influences outcomes in pediatric and congenital cardiovascular disease?: A healthy lifestyle; obesity and overweight. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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MacCosham B, Gravelle F, Morin J. Towards a Better Understanding of Physical Activity Behavior in Adults with Congenital Heart Disease. AMERICAN JOURNAL OF HEALTH EDUCATION 2019. [DOI: 10.1080/19325037.2019.1642812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Niwa K. Metabolic Syndrome in Adult Congenital Heart Disease. Korean Circ J 2019; 49:691-708. [PMID: 31347322 PMCID: PMC6675699 DOI: 10.4070/kcj.2019.0187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In adult congenital heart disease (ACHD), residua and sequellae after initial repair develop late complications such as cardiac failure, arrhythmias, thrombosis, aortopathy, pulmonary hypertension and others. Acquired lesions with aging such as hypertension, diabetes mellitus, obesity can be negative influence on original cardiovascular disease (CVD). Also, atherosclerosis may pose an additional health problem to ACHD when they grow older and reach the age at which atherosclerosis becomes clinically relevant. In spite of the theoretical risk of atherosclerosis in ACHD due to above mentioned factors, cyanotic ACHDs even after repair are noted to have minimal incidence of coronary artery disease (CAD). Acyanotic ACHD has similar prevalence of CAD as the general population. However, even in cyanotic ACHD, CAD can develop when they have several risk factors for CAD. The prevalence of risk factor is similar between ACHD and the general population. Risk of premature atherosclerotic CVD in ACHD is based, 3 principal mechanisms: lesions with coronary artery abnormalities, obstructive lesions of left ventricle and aorta such as coarctation of the aorta and aortopathy. Coronary artery abnormalities are directly affected or altered surgically, such as arterial switch in transposition patients, may confer greater risk for premature atherosclerotic CAD. Metabolic syndrome is more common among ACHD than in the general population, and possibly increases the incidence of atherosclerotic CAD even in ACHD in future. Thus, ACHD should be screened for metabolic syndrome and eliminating risk factors for atherosclerotic CAD.
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Affiliation(s)
- Koichiro Niwa
- Cardiovascular Center, Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Perin F, Carreras Blesa C, Rodríguez Vázquez del Rey MDM, Cobo I, Maldonado J. Overweight and obesity in children treated for congenital heart disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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A diet high in sugar-sweetened beverage and low in fruits and vegetables is associated with adiposity and a pro-inflammatory adipokine profile. Br J Nutr 2018; 120:1230-1239. [PMID: 30375290 DOI: 10.1017/s0007114518002726] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diet, obesity and adipokines play important roles in diabetes and CVD; yet, limited studies have assessed the relationship between diet and multiple adipokines. This cross-sectional study assessed associations between diet, adiposity and adipokines in Mexican Americans. The cohort included 1128 participants (age 34·7±8·2 years, BMI 29·5±5·9 kg/m2, 73·2 % female). Dietary intake was assessed by 12-month food frequency questionnaire. Adiposity was measured by BMI, total percentage body fat and percentage trunk fat using dual-energy X-ray absorptiometry. Adiponectin, apelin, C-reactive protein (CRP), dipeptidyl peptidase-4 (DPP-IV), IL-1β, IL-1ra, IL-6, IL-18, leptin, lipocalin, monocyte chemo-attractant protein-1 (MCP-1), resistin, secreted frizzled protein 4 (SFRP-4), SFRP-5, TNF-α and visfatin were assayed with multiplex kits or ELISA. Joint multivariate associations between diet, adiposity and adipokines were analysed using canonical correlations adjusted for age, sex, energy intake and kinship. The median (interquartile range) energy intake was 9514 (7314, 11912) kJ/d. Overall, 55 % of total intake was accounted for by carbohydrates (24 % from sugar). A total of 66 % of the shared variation between diet and adiposity, and 34 % of diet and adipokines were explained by the top canonical correlation. The diet component was most represented by sugar-sweetened beverages (SSB), fruit and vegetables. Participants consuming a diet high in SSB and low in fruits and vegetables had higher adiposity, CRP, leptin, and MCP-1, but lower SFRP-5 than participants with high fruit and vegetable and low SSB intake. In Mexican Americans, diets high in SSB but low in fruits and vegetables contribute to adiposity and a pro-inflammatory adipokine profile.
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Englert JAR, Gupta T, Joury AU, Shah SB. Tetralogy of Fallot: Case-Based Update for the Treatment of Adult Congenital Patients. Curr Probl Cardiol 2018; 44:46-81. [PMID: 30172549 DOI: 10.1016/j.cpcardiol.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 487] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:1494-1563. [PMID: 30121240 DOI: 10.1016/j.jacc.2018.08.1028] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Perin F, Carreras Blesa C, Rodríguez Vázquez Del Rey MDM, Cobo I, Maldonado J. [Overweight and obesity in children treated for congenital heart disease]. An Pediatr (Barc) 2018; 90:102-108. [PMID: 29691131 DOI: 10.1016/j.anpedi.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The negative impact of overweight and obesity is potentially greater in children affected by a congenital heart disease (CHD). The aim of this study is to calculate the proportion of overweight and obesity in children who underwent an intervention for CHD, and to investigate systolic arterial hypertension as a possible early cardiovascular complication. PATIENTS AND METHODS A retrospective study was conducted on patients aged 6-17 years treated for CHD, and healthy control subjects, followed-up in a Paediatric Cardiology Clinic. Body mass index percentiles were calculated according to the criteria of WHO. A review was performed on the anthropometric and clinical data, as well as the systolic blood pressure (SBP). RESULTS A total of 440 patients were included, of which 220 had CHD. The proportion of combined obesity and overweight (body mass index percentile ≥85) was 36.4% (37.3% in healthy subjects and 35.4% in patients with CHD, P=.738). A higher prevalence of obesity (body mass index percentile ≥97) was found in CHD patients (22.7%) compared to 15.5% in healthy subjects (P=.015). SBP percentiles were higher in overweight compared to normal-weight patients (P < .001). The prevalence of SBP readings ≥ the 95th percentile was greater in overweight than in normal weight CHD patients (29.5% versus 7.7%, P < .001) and also in the overweight healthy controls compared to those of normal weight (12.2% versus 0.7%, P < .001). CONCLUSIONS The proportion of obesity is high in children treated for CHD and it is associated with elevated SBP levels. The risk of long-term complications needs to be reduced by means of prevention and treatment of obesity in this vulnerable population.
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Affiliation(s)
- Francesca Perin
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - Carmen Carreras Blesa
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - Inmaculada Cobo
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España
| | - José Maldonado
- Unidad de Gastroenterología, Hepatología y Nutrición, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, España; Instituto de Investigación Biosanitaria (ibs), Granada, España; Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, España
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Feng Y, Cai J, Tong X, Chen R, Zhu Y, Xu B, Mo X. Non-inheritable risk factors during pregnancy for congenital heart defects in offspring: A matched case-control study. Int J Cardiol 2018; 264:45-52. [PMID: 29685690 DOI: 10.1016/j.ijcard.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/04/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yu Feng
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Jun Cai
- Ministry of Education Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Joint Center for Global Change Studies, Beijing 100875, China
| | - Xing Tong
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Runsen Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Yu Zhu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Bing Xu
- Ministry of Education Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Joint Center for Global Change Studies, Beijing 100875, China.
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.
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Pachucki MC, Karter AJ, Adler NE, Moffet HH, Warton EM, Schillinger D, O'Connell BH, Laraia B. Eating with others and meal location are differentially associated with nutrient intake by sex: The Diabetes Study of Northern California (DISTANCE). Appetite 2018; 127:203-213. [PMID: 29601920 DOI: 10.1016/j.appet.2018.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/23/2017] [Accepted: 03/23/2018] [Indexed: 02/07/2023]
Abstract
Though eating with others is often a social behavior, relationships between social contexts of eating and nutrient intake have been underexplored. This study evaluates how social aspects of eating - frequencies of eating meals with others, meals prepared at home, and meals outside the home - are associated with nutrient intake. Because diet improvement can reduce complications of diabetes mellitus, we surveyed a multi-ethnic cohort of persons with type 2 diabetes (n = 770) about social aspects of diet (based on 24-hour recalls). Sex-stratified multiple regression analyses adjusted for confounders assessed the relationship between frequency of eating with others and nutrient intake (total energy, energy from fat, energy from carbohydrates, Healthy Eating Index/HEI, Dietary Approaches to Stop Hypertension/DASH score). Although there was slight variation in men's versus women's propensity to share meals, after adjustment for confounders, there was no consistently significant association between meals with others and the 5 nutrient intake measures for either men or women. The directions of association between categories of eating with others and diet quality (HEI and DASH scores) - albeit not significant - were different for men (positive) and women (mostly negative), which warrants further investigation. The next analyses estimated nutrient intake associated with meals prepared at home, and meals consumed outside the home. Analyses indicated that greater meal frequency at home was associated with significantly better scores on diet quality indices for men (but not women), while meal frequency outside the home was associated with poorer diet quality and energy intake for women (but not men). Better measurement of social dimensions of eating may inform ways to improve nutrition, especially for persons with diabetes for whom diet improvement can result in better disease outcomes.
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Affiliation(s)
- Mark C Pachucki
- Department of Sociology and Computational Social Science Institute, University of Massachusetts, Amherst, 200 Hicks Way, Thompson Hall, Amherst, MA 01003-9277, United States.
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, 3333 California Street, Suite 465, San Francisco, CA 94118, United States
| | - Howard H Moffet
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States
| | - E Margaret Warton
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States
| | - Dean Schillinger
- Department of Medicine, University of California, San Francisco, Box 1364, SFGH Bldg 10, Ward 13 1310, San Francisco, CA 94143, United States
| | | | - Barbara Laraia
- School of Public Health, University of California, Berkeley, 207-B University Hall, Berkeley, CA 94720-97360, United States
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Flannery LD, Fahed AC, DeFaria Yeh D, Youniss MA, Barinsky GL, Stefanescu Schmidt AC, Benavidez OJ, Meigs JB, Bhatt AB. Frequency of Guideline-Based Statin Therapy in Adults With Congenital Heart Disease. Am J Cardiol 2018; 121:485-490. [PMID: 29268935 DOI: 10.1016/j.amjcard.2017.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022]
Abstract
We aimed to evaluate atherosclerotic cardiovascular disease (ASCVD) risk estimates and guideline-based statin use for primary prevention of ASCVD in adults with congenital heart disease (ACHD). This was a case-controlled, retrospective study of 248 cases and 744 age- and gender-matched controls at a tertiary care referral center. ASCVD risk scores were calculated and used to assess indication for statin treatment for primary prevention per the 2013 American College of Cardiology and American Heart Association guideline on assessment of cardiovascular risk. There were no differences in average 10-year ASCVD risk scores between ACHD cases (4.6% ± 6.6%) and matched controls (5.1% ± 6.7%, p = 0.32). ACHD cases had lower total cholesterol (183 ± 38 vs 192.6 ± 35.3 mg/dL, p < 0.001) and were less likely to smoke (8.1% vs 14.6%, p = 0.008), yet had lower high density lipoprotein (52.6 ± 17.2 vs 55.3 ± 17.1 mg/dL, p = 0.03) and higher hypertension rates (38.7% vs 28.5%, p = 0.003). However, only 42.3% ACHD cases with a primary prevention statin indication were appropriately prescribed therapy as compared with 59.0% of controls (p = 0.04). In conclusion, ACHD cases have a similar 10-year ASCVD risk score than age- and gender-matched peers, but ACHD cases are less likely than their peers to be prescribed statin therapy for primary prevention per guideline-based recommendations.
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Powell A. Exercise in congenital heart disease: A contemporary review of the literature. HEART AND MIND 2018. [DOI: 10.4103/hm.hm_38_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Olsen M, Marino B, Kaltman J, Laursen H, Jakobsen L, Mahle W, Pearson G, Madsen N. Myocardial Infarction in Adults With Congenital Heart Disease. Am J Cardiol 2017; 120:2272-2277. [PMID: 29111211 DOI: 10.1016/j.amjcard.2017.08.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/27/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
Abstract
We compared the incidence and 30-day mortality of myocardial infarction (MI) in adults with congenital heart disease (CHD) relative to the general population. This cohort study used nationwide population-based medical databases to identify individuals born before 1982 and diagnosed with CHD in Denmark between 1963 and 2012. Patients were followed for first-time MI using data from the Danish National Registry of Patients. For each subject with CHD, we identified 10 controls from the general population, matched by sex and birth year. A unique personal identifier enabled follow-up for migration, death, or MI. We computed cumulative incidences and hazard ratios (HR) adjusted for birth year and sex for MI and 30-day mortality after MI. We identified 10,501 CHD adults alive at 30 years. By 70 years of age, the cumulative incidence of MI was 10% versus 6.5% for controls. The overall HR of MI in subjects with CHD compared with controls was 2.0 (95% CI 1.7 to 2.3). The 30-day mortality was 18% for the 296 subjects with CHD experiencing an MI during follow-up. The overall HR comparing 30-day mortality after MI between subjects with CHD and controls was 1.4 (95% CI 1.0 to 1.8). The greatest mortality was observed in adults with severe CHD (HR 2.7 [95% CI 1.5 to 5.0]). In conclusion, the incidence of MI and the 30-day mortality after MI for severe CHD were increased in adults with CHD compared with the general population. Underlying mechanisms need to be clarified.
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Affiliation(s)
- Morten Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Bradley Marino
- Heart Center at the Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Henning Laursen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - William Mahle
- Department of Pediatrics, Division of Cardiology, Emory University Atlanta, Atlanta, Georgia
| | - Gail Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Nicolas Madsen
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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Passive range of motion exercise to enhance growth in infants following the Norwood procedure: a safety and feasibility trial. Cardiol Young 2017; 27:1361-1368. [PMID: 28330522 PMCID: PMC5712224 DOI: 10.1017/s1047951117000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and feasibility of a passive range of motion exercise programme for infants with CHD. Study design This non-randomised pilot study enrolled 20 neonates following Stage I palliation for single-ventricle physiology. Trained physical therapists administered standardised 15-20-minute passive range of motion protocol, for up to 21 days or until hospital discharge. Safety assessments included vital signs measured before, during, and after the exercise as well as adverse events recorded through the pre-Stage II follow-up. Feasibility was determined by the percent of days that >75% of the passive range of motion protocol was completed. RESULTS A total of 20 infants were enrolled (70% males) for the present study. The median age at enrolment was 8 days (with a range from 5 to 23), with a median start of intervention at postoperative day 4 (with a range from 2 to 12). The median hospital length of stay following surgery was 15 days (with a range from 9 to 131), with an average of 13.4 (with a range from 3 to 21) in-hospital days per patient. Completion of >75% of the protocol was achieved on 88% of eligible days. Of 11 adverse events reported in six patients, 10 were expected with one determined to be possibly related to the study intervention. There were no clinically significant changes in vital signs. At pre-Stage II follow-up, weight-for-age z-score (-0.84±1.20) and length-for-age z-score (-0.83±1.31) were higher compared with historical controls from two earlier trials. CONCLUSION A passive range of motion exercise programme is safe and feasible in infants with single-ventricle physiology. Larger studies are needed to determine the optimal duration of passive range of motion and its effect on somatic growth.
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Abstract
Obesity is increasingly prevalent, and abnormal body mass index is a risk factor for cardiovascular disease. There are limited data published regarding body mass index and CHD. We tested the hypothesis that body mass index and obesity prevalence are increasing in patients with tetralogy of Fallot over time by analysing time since surgery, age, height, weight, and body mass index among tetralogy of Fallot patients and demographic data from age-matched controls. NYHA class and left ventricular ejection fraction were analysed in adults. Body mass index was categorised into normal, overweight, and obese in this single-centre, retrospective chart review. Data were collected from 137 tetralogy of Fallot patients (71 men:66 women), of whom 40 had body mass index >25 kg/m2. Tetralogy of Fallot patients aged <6 years had lower body mass index (15.9 versus 17.1; p=0.042) until 16-20 years of age (27.4 versus 25.4; p=0.43). For adult tetralogy of Fallot patients, the mean body mass index was 26.5 but not statistically significantly different from the control cohort. Obese adult patients had significantly higher average NYHA class compared with those of normal weight (p=0.03), but no differences in left ventricular ejection fraction by echocardiography (p=0.55) or cardiac MRI (p=0.26) were noted. Lower body mass index was observed initially in tetralogy of Fallot patients, but by late adolescence no significant difference was observed. As adults, tetralogy of Fallot patients with higher body mass index had increased NYHA class but similar left ventricular ejection fraction.
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50
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Fink DL, Machluf Y, Farkash R, Weisz G, Pirogovsky A, Tal O, Dagan D, Chaiter Y. Cardiac anomalies and associated comorbidities in a large adolescent population. Int J Adolesc Med Health 2017; 31:ijamh-2017-0020. [PMID: 28614051 DOI: 10.1515/ijamh-2017-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the prevalence, secular trends and associations of heart disease in a large unscreened, otherwise basically healthy, adolescent population. SUBJECTS AND METHODS Cross-sectional study of the cardiac status of 113,694 adolescents from the northern district of Israel, who completed the profiling process between the ages of 16 and 19, including all essential measures over a 22-year period. Results of imaging were categorized as either isolated valvar or structural abnormalities, and their clinically significant subgroups defined prospectively. The findings were correlated with the socio-demographic and anthropometric data and non-cardiac health conditions. RESULTS Of those sent for echocardiography, 1257 (0.93% of the total population) had isolated valvar disease and 216 (0.19%) had structural abnormalities, with 20% of both groups considered significant. Females had lower prevalence of heart disease. There was peak prevalence in the second 5-year period. Tall subjects or a past history of rheumatic fever had more valvar abnormalities. Thin subjects or those with skeletal anomalies had more structural abnormalities. Significant valvar and structural anomalies were more common in subjects with learning disorders, endocrine disorders and diabetes mellitus. Fewer valvar abnormalities were diagnosed in obese subjects. Heart disease was more common in those with non-solid tumors. CONCLUSION Appreciable numbers of potentially healthy adolescents were found to have heart disease. There appeared to be an association with body size, skeletal abnormalities and relatively common medical disorders, the cause of which remains to be determined in prospective studies that could change the way common adolescent disease should be followed.
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Affiliation(s)
- Daniel Lyon Fink
- Shaare Zedek Medical Center, Jerusalem, Israel
- Medical Corps, Israel Defense Forces (IDF), Tel Aviv, Israel
| | - Yossy Machluf
- Medical Corps, Israel Defense Forces (IDF), Tel Aviv, Israel
| | | | - Giora Weisz
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avinoam Pirogovsky
- Medical Corps, Israel Defense Forces (IDF), Tel Aviv, Israel
- Schneider Children Medical Center, Petah Tikva, Israel
| | - Orna Tal
- Assaf Harofeh Medical Center, Tzrifin, Israel
| | - David Dagan
- Medical Corps, Israel Defense Forces (IDF), Tel Aviv, Israel
| | - Yoram Chaiter
- Head of Quality Assurance and Control of Medical Committees, Medical Corps (IDF), Epidemiologist, Pinsker 72 street, Haifa 32712, Israel, Phone: +972-4-8320751; +972-50-5510044
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