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Zielonka B, Bucholz EM, Lu M, Bates KE, Hill GD, Pinto NM, Sleeper LA, Brown DW. Childhood Opportunity and Acute Interstage Outcomes: A National Pediatric Cardiology Quality Improvement Collaborative Analysis. Circulation 2024; 150:190-202. [PMID: 39008557 PMCID: PMC11251506 DOI: 10.1161/circulationaha.124.069127] [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: 02/12/2024] [Revised: 05/14/2024] [Accepted: 06/05/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The interstage period after discharge from stage 1 palliation carries high morbidity and mortality. The impact of social determinants of health on interstage outcomes is not well characterized. We assessed the relationship between childhood opportunity and acute interstage outcomes. METHODS Infants discharged home after stage 1 palliation in the National Pediatric Quality Improvement Collaborative Phase II registry (2016-2022) were retrospectively reviewed. Zip code-level Childhood Opportunity Index (COI), a composite metric of 29 indicators across education, health and environment, and socioeconomic domains, was used to classify patients into 5 COI levels. Acute interstage outcomes included death or transplant listing, unplanned readmission, intensive care unit admission, unplanned catheterization, and reoperation. The association between COI level and acute interstage outcomes was assessed using logistic regression with sequential adjustment for potential confounders. RESULTS The analysis cohort included 1837 patients from 69 centers. Birth weight (P<0.001) and proximity to a surgical center at birth (P=0.02) increased with COI level. Stage 1 length of stay decreased (P=0.001), and exclusive oral feeding rate at discharge increased (P<0.001), with higher COI level. More than 98% of patients in all COI levels were enrolled in home monitoring. Death or transplant listing occurred in 101 (5%) patients with unplanned readmission in 987 (53%), intensive care unit admission in 448 (24%), catheterization in 345 (19%), and reoperation in 83 (5%). There was no difference in the incidence or time to occurrence of any acute interstage outcome among COI levels in unadjusted or adjusted analysis. There was no interaction between race and ethnicity and childhood opportunity in acute interstage outcomes. CONCLUSIONS Zip code COI level is associated with differences in preoperative risk factors and stage 1 palliation hospitalization characteristics. Acute interstage outcomes, although common across the spectrum of childhood opportunity, are not associated with COI level in an era of highly prevalent home monitoring programs. The role of home monitoring in mitigating disparities during the interstage period merits further investigation.
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Affiliation(s)
- Benjamin Zielonka
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
| | - Emily M. Bucholz
- Section of Cardiology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado, Denver (E.M.B.)
| | - Minmin Lu
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
| | - Katherine E. Bates
- Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor (K.E.B.)
| | - Garick D. Hill
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, OH (G.D.H.)
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, WA (N.M.P.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
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Shalhoub K, Heydarian HC, Hanke SP, Cnota JF, Stein LH, Tepe B, Hill GD. Achieving an Optimal Outcome After Stage 1 Palliation for Hypoplastic Left Heart Syndrome and Variants: Frequency, Associated Factors, and Subsequent Outcomes. J Am Heart Assoc 2024; 13:e032055. [PMID: 38860404 PMCID: PMC11255728 DOI: 10.1161/jaha.123.032055] [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: 08/03/2023] [Accepted: 04/18/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND We sought to measure frequency of achieving an optimal outcome after stage 1 palliation (S1P) for hypoplastic left heart syndrome and variants, determine factors associated with optimal outcomes, and compare outcomes after stage 2 palliation (S2P) using the National Pediatric Cardiology Quality Improvement Collaborative database (2008-2016). METHODS AND RESULTS This is a retrospective cohort study with optimal outcome defined a priori as meeting all of the following: (1) discharge after S1P in <19 days (top quartile), (2) no red flag or major event readmissions before S2P, and (3) performing S2P between 90 and 240 days of age. Optimal outcome was achieved in 256 of 2182 patients (11.7%). Frequency varied among centers from 0% to 25%. Factors independently associated with an optimal outcome after S1P were higher gestational age (odds ratio [OR], 1.1 per week [95% CI, 1.0-1.2]; P=0.02); absence of a genetic syndrome (OR, 2.5 [95% CI, 1.2-5]; P=0.02); not requiring a post-S1P catheterization (OR, 2.7 [95% CI, 1.5-4.8]; P=0.01), intervention (OR, 1.5 [95% CI, 1.1-2]; P=0.006), or a procedure (OR, 4.5 [95% CI, 2.8-7.1]; P<0.001) before discharge; and not having a post-S1P complication (OR, 2.7 [95% CI, 1.9-3.7]; P<0.001). Those with an optimal outcome after S1P had improved S2P outcomes including shorter length of stay, less ventilator days, shorter bypass time, and fewer postoperative complications. CONCLUSIONS Identifying patients at lowest risk for poor outcomes during the home interstage period could shift necessary resources to those at higher risk, alter S2P postoperative expectations, and improve quality of life for families at lower risk.
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Affiliation(s)
- Khayri Shalhoub
- Department of PediatricsBaylor College of MedicineHoustonTXUSA
- Section of Critical Care Medicine & CardiologyTexas Children’s HospitalHoustonTXUSA
| | - Haleh C. Heydarian
- Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Samuel P. Hanke
- Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - James F. Cnota
- Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Laurel H. Stein
- Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Brooke Tepe
- Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Garick D. Hill
- Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
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Tandon A, Avari Silva JN, Bhatt AB, Drummond CK, Hill AC, Paluch AE, Waits S, Zablah JE, Harris KC. Advancing Wearable Biosensors for Congenital Heart Disease: Patient and Clinician Perspectives: A Science Advisory From the American Heart Association. Circulation 2024; 149:e1134-e1142. [PMID: 38545775 DOI: 10.1161/cir.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Wearable biosensors (wearables) enable continual, noninvasive physiologic and behavioral monitoring at home for those with pediatric or congenital heart disease. Wearables allow patients to access their personal data and monitor their health. Despite substantial technologic advances in recent years, issues with hardware design, data analysis, and integration into the clinical workflow prevent wearables from reaching their potential in high-risk congenital heart disease populations. This science advisory reviews the use of wearables in patients with congenital heart disease, how to improve these technologies for clinicians and patients, and ethical and regulatory considerations. Challenges related to the use of wearables are common to every clinical setting, but specific topics for consideration in congenital heart disease are highlighted.
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Genna C, Thekkan KR, Geremia C, Di Furia M, Cecchetti C, Rufini E, Salata M, Perrotta D, Dall'Oglio I, Tiozzo E, Raponi M, Gawronski O. Parents' Trigger Tool for Children with Medical Complexity - PAT-CMC: Development of a recognition tool for clinical deterioration at home. J Adv Nurs 2024. [PMID: 38661213 DOI: 10.1111/jan.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
AIM To develop a trigger tool for parents and lay caregivers of children with medical complexity (CMC) at home and to validate its content. DESIGN This was a multi-method study, using qualitative data, a Delphi method and a concept mapping approach. METHODS A three-round electronic Delphi was performed from December 2021 to April 2022 with a panel of 23 expert parents and 30 healthcare providers, supplemented by a preliminary qualitative exploration of children's signs of deterioration and three consensus meetings to develop the PArents' Trigger Tool for Children with Medical Complexity (PAT-CMC). Cognitive interviews with parents were performed to assess the comprehensiveness and comprehensibility of the tool. The COREQ checklist, the COSMIN guidelines and the CREDES guidelines guided the reporting respectively of the qualitative study, the development and content validity of the trigger tool and the Delphi study. RESULTS The PAT-CMC was developed and its content validated to recognize clinical deterioration at home. The tool consists of 7 main clusters of items: Breathing, Heart, Devices, Behaviour, Neuro-Muscular, Nutrition/Hydration and Other Concerns. A total of 23 triggers of deterioration were included and related to two recommendations for escalation of care, using a traffic light coding system. CONCLUSION Priority indicators of clinical deterioration of CMC were identified and integrated into a validated trigger tool designed for parents or other lay caregivers at home, to recognize signs of acute severe illness and initiate healthcare interventions. IMPACT The PAT-CMC was developed to guide families in recognizing signs of deterioration in CMC and has potential for initiating an early escalation of care. This tool may also be useful to support education provided by healthcare providers to families before hospital discharge. PATIENT OR PUBLIC CONTRIBUTION Parents of CMC were directly involved in the selection of relevant indicators of children's clinical deterioration and the development of the trigger tool. They were not involved in the design, conducting, reporting or dissemination plans of this research.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesia, Resuscitation and Surgical Compartment, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emilia Rufini
- Pediatric Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michele Salata
- Center for Pediatric Palliative Care, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Daniela Perrotta
- Department of Anesthesia, Resuscitation and Surgical Compartment, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Sump C, Odum JD, Pfarr MA. Putting equity at the forefront as telehealth advances: A hospitalist perspective. J Hosp Med 2024; 19:223-226. [PMID: 37183321 DOI: 10.1002/jhm.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Courtney Sump
- Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James D Odum
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie A Pfarr
- Department of Pediatrics, Division of Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Frank LH, Glickstein J, Brown DW, Mink RB, Ross RD. Child Health Needs and the Pediatric Cardiology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678E. [PMID: 38300014 PMCID: PMC10852197 DOI: 10.1542/peds.2023-063678e] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article evaluates the pediatric cardiology (PC) workforce and forecasts its future supply. Produced as part of a supplement in Pediatrics, this effort represents a collaboration among the American Board of Pediatrics Foundation, the University of North Carolina at Chapel Hill's Carolina Health Workforce Research Center, the Strategic Modeling and Analysis Ltd., and members of the pediatric subspecialty community. PC is a complex subspecialty including care from fetal life through adulthood and in practice settings that range from the outpatient clinic to procedural settings to the cardiac ICU. Complex subdisciplines include imaging, electrophysiology, heart failure, and interventional and critical care. Using American Board of Pediatrics data, US Census Bureau data, and data from the modeling project, projections were created to model the subspecialty workforce through 2040. Across all modeling scenarios considered, there is considerable projected growth in the supply of pediatric cardiologists by 2040. However, there is significant regional variation in the projected supply of trainees relative to demand in terms of local population growth, with evidence of a likely mismatch between areas surrounding training centers versus areas of greatest workforce need. In addition, this article highlights areas for future focus, including efforts to attract more residents to the subspecialty in general, particularly underrepresented minority members; increased support, more part-time career options, and improved academic career advancement for women in PC; and the development of better "real-time" workforce data to guide trainees and training programs in decisions regarding sub-subspecialty job availability.
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Affiliation(s)
- Lowell H. Frank
- Division of Cardiology, Children’s National Hospital, Washington, District of Columbia
| | - Julie Glickstein
- Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, New York
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Richard B. Mink
- David Geffen School of Medicine at the University of California Los Angeles, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, Torrance
| | - Robert D. Ross
- Division of Cardiology, Children’s Hospital of Michigan, Detroit, Michigan
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Kumar SR, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Husain SA, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for centers performing pediatric heart surgery in the United States. J Thorac Cardiovasc Surg 2023; 166:1782-1820. [PMID: 37777958 DOI: 10.1016/j.jtcvs.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minn
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Mich
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | | | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Md
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, Calif
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Ariz
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Mo
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Va
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, Calif
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Nashville, Tenn
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Mich
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Balsara SL, Burstein D, Ittenbach RF, Kaplinski M, Gardner MM, Ravishankar C, Rossano J, Goldberg DJ, Mahle M, O'Connor MJ, Mascio CE, Gaynor JW, Preminger TJ. Combined ventricular dysfunction and atrioventricular valve regurgitation after the Norwood procedure are associated with attrition prior to superior cavopulmonary connection. JTCVS OPEN 2023; 16:714-725. [PMID: 38204707 PMCID: PMC10775094 DOI: 10.1016/j.xjon.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/03/2023] [Accepted: 09/21/2023] [Indexed: 01/12/2024]
Abstract
Background Infants with hypoplastic left heart syndrome (HLHS) or a variant are at risk of ventricular dysfunction (VD) and atrioventricular valve regurgitation (AVVR) prior to superior cavopulmonary connection (SCPC). Although the impact of these complications in isolation has been described, their effect in combination on attrition is poorly defined. Methods A retrospective observational study of patients with HLHS or variants undergoing a Norwood procedure between 2008 and 2020 at a single center was performed. VD and AVVR were defined as moderate or severe when seen on 2 sequential echocardiograms outside the perioperative period. Attrition was defined as death, listing for heart transplant, or unsuitability for SCPC or transplant. Descriptive statistics and regression models were used for analysis. Results A total of 397 patients were included, of whom 75% had HLHS and 57% had received a Blalock-Thomas-Taussig shunt. Isolated VD occurred in 9% of patients, AVVR occurred in 13%, and both occurred in 6%. Attrition prior to SCPC occurred in 19% of the overall cohort, in 52% of patients with combined VD and AVVR (odds ratio [OR], 5.2; 95% confidence interval [CI], 2.3-12.0; P < .01), 26% of those with VD (OR, 1.5; 95% CI, 0.7-3.3; P = .32), 25% of those with AVVR (OR, 1.5; 95% CI, 0.7-2.9; P = .27), and 15% in those with neither (OR, 0.3; 95% CI, 0.2-0.6; P < .01). Other factors associated with attrition included prematurity, total bypass time at Norwood, and extracorporeal membrane oxygenation after Norwood, whereas later year of Norwood was protective (P < .01 for all). Conclusions The presence of combined VD and AVVR markedly increases the likelihood of attrition prior to SCPC, identifying a high-risk group.
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Affiliation(s)
| | - Danielle Burstein
- The Children's Hospital of Philadelphia, Philadelphia, Pa
- University of Vermont Medical Center, Burlington, Vt
| | | | | | | | | | - Joseph Rossano
- The Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | - Marlene Mahle
- The Children's Hospital of Philadelphia, Philadelphia, Pa
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10
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Stagg A, Giglia TM, Gardner MM, Shustak RJ, Natarajan SS, Hehir DA, Szwast AL, Rome JJ, Ravishankar C, Preminger TJ. Feasibility of Digital Stethoscopes in Telecardiology Visits for Interstage Monitoring in Infants with Palliated Congenital Heart Disease. Pediatr Cardiol 2023; 44:1702-1709. [PMID: 37285041 PMCID: PMC10246546 DOI: 10.1007/s00246-023-03198-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. Interstage telecardiology visits (TCV) have been effective in identifying clinical concerns and preventing unnecessary emergency department visits in this high-risk population. We aimed to assess the feasibility of implementing auscultation with digital stethoscopes (DSs) during TCV and the potential impact on interstage care in our Infant Single Ventricle Monitoring & Management Program. In addition to standard home-monitoring practice for TCV, caregivers received training on use of a DS (Eko CORE attachment assembled with Classic II Infant Littman stethoscope). Sound quality of the DS and comparability to in-person auscultation were evaluated based on two providers' subjective assessment. We also evaluated provider and caregiver acceptability of the DS. From 7/2021 to 6/2022, the DS was used during 52 TCVs in 16 patients (median TCVs/patient: 3; range: 1-8), including 7 with hypoplastic left heart syndrome. Quality of heart sounds and murmur auscultation were subjectively equivalent to in-person findings with excellent inter-rater agreement (98%). All providers and caregivers reported ease of use and confidence in evaluation with the DS. In 12% (6/52) of TCVs, the DS provided additional significant information compared to a routine TCV; this expedited life-saving care in two patients. There were no missed events or deaths. Use of a DS during TCV was feasible in this fragile cohort and effective in identifying clinical concerns with no missed events. Longer term use of this technology will further establish its role in telecardiology.
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Affiliation(s)
- Alyson Stagg
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Therese M Giglia
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique M Gardner
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel J Shustak
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Hehir
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anita L Szwast
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan J Rome
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chitra Ravishankar
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tamar J Preminger
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Staehler H, Schaeffer T, Wasner J, Lemmer J, Adam M, Burri M, Hager A, Ewert P, Hörer J, Ono M, Heinisch PP. Impact of home monitoring program on interstage mortality after the Norwood procedure. Front Cardiovasc Med 2023; 10:1239477. [PMID: 37900558 PMCID: PMC10600023 DOI: 10.3389/fcvm.2023.1239477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Objective While early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, interstage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) decrease interstage mortality. Methods Among 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding interstage mortality. In patients with HMP, events during the interstage period were evaluated. Results Interstage mortality was 8% (n = 21), and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with interstage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extra corporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for interstage mortality. Most frequent event during home monitoring was low saturation (<70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnated weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmias in 2 (2.5%). An unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups. Conclusions Interstage HMP permits timely intervention and led to an important decrease in interstage mortality. One-third of the patients with home monitoring program needed re-admission and demonstrated the need for earlier stage 2 palliation.
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Affiliation(s)
- Helena Staehler
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Johanna Wasner
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Julia Lemmer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Michel Adam
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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12
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Patel PS, Shah SK, Feldman K, Hancock HS, Moehlmann ML, Ricketts A, Files MD, McFarland C, Erickson L, Romans RA. Associations of Home Monitoring Data to Interventional Catheterization for Infants with Recurrent Coarctation of the Aorta and Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2023; 44:1462-1470. [PMID: 37421465 DOI: 10.1007/s00246-023-03224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
The post-Norwood interstage period for infants with hypoplastic left heart syndrome is a high-risk time with 10-20% of infants having a complication of recurrent coarctation of the aorta (RCoA). Many interstage programs utilize mobile applications allowing caregivers to submit home physiologic data and videos to the clinical team. This study aimed to investigate if caregiver-entered data resulted in earlier identification of patients requiring interventional catheterization for RCoA. Retrospective home monitoring data were extracted from five high-volume Children's High Acuity Monitoring Program®-affiliated centers (defined as contributing > 20 patients to the registry) between 2014 and 2021 after IRB approval. Demographics and caregiver-recorded data evaluated include weight, heart rate (HR), oxygen saturation (SpO2), video recordings, and 'red flag' concerns prior to interstage readmissions. 27% (44/161) of infants required interventional catheterization for RCoA. In the 7 days prior to readmission, associations with higher odds of RCoA included (mean bootstrap coefficient, [90% CI]) increased number of total recorded videos (1.65, [1.07-2.62]) and days of recorded video (1.62, [1.03-2.59]); increased number of total recorded weights (1.66, [1.09-2.70]) and days of weights (1.56, [1.02-2.44]); increasing mean SpO2 (1.55, [1.02-2.44]); and increased variation and range of HR (1.59, [1.04-2.51]) and (1.71, [1.10-2.80]), respectively. Interstage patients with RCoA had increased caregiver-entered home monitoring data including weight and video recordings, as well as changes in HR and SpO2trends. Identifying these items by home monitoring teams may be beneficial in clinical decision-making for evaluation of RCoA in this high-risk population.
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Affiliation(s)
- Parth S Patel
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Shil K Shah
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Keith Feldman
- University of Missouri-Kansas City School of Medicine, Health Outcomes and Health Services Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Hayley S Hancock
- Ward Family Heart Center, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Matthew L Moehlmann
- Ward Family Heart Center, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Amy Ricketts
- Remote Health Solutions, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Matthew D Files
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Carol McFarland
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Lori Erickson
- Remote Health Solutions, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ryan A Romans
- Ward Family Heart Center, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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13
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Hassan A, Chegondi M, Porayette P. Five decades of Fontan palliation: What have we learned? What should we expect? J Int Med Res 2023; 51:3000605231209156. [PMID: 37910851 PMCID: PMC10621298 DOI: 10.1177/03000605231209156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
The Fontan procedure is the final palliative surgery in a series of staged surgeries to reroute the systemic venous blood flow directly to the lungs, with the ventricle(s) pumping oxygenated blood to the body. Advances in medical and surgical techniques have improved patients' overall survival after the Fontan procedure. However, Fontan-associated chronic comorbidities are common. In addition to chronic cardiac dysfunction and arrhythmias, complications involving other organs such as the liver, lungs, intestine, lymphatic system, brain, and blood frequently occur. This narrative review focuses on the immediate and late consequences in children, pregnant women, and other adults with Fontan circulation. In addition, we describe the technical advancements that might change the way single-ventricle patients are managed in future.
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Affiliation(s)
- Adil Hassan
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Madhuradhar Chegondi
- Division of Pediatric Critical Care Medicine, Stead Family Children’s Hospital, University of Iowa, Iowa City, IA 52242, USA
| | - Prashob Porayette
- Division of Pediatric Cardiology, Stead Family Children’s Hospital, University of Iowa, Iowa City, IA 52242, USA
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14
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Shustak RJ, Huang J, Tam V, Stagg A, Giglia TM, Ravishankar C, Mercer‐Rosa L, Guevara JP, Gardner MM. Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program. J Am Heart Assoc 2023; 12:e030029. [PMID: 37702068 PMCID: PMC10547291 DOI: 10.1161/jaha.123.030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
Background Poor interstage weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome. We sought to examine the association of neighborhood social vulnerability and interstage weight gain and determine if this association is modified by enrollment in our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP). Methods and Results We performed a retrospective single-center study of infants with hypoplastic left heart syndrome before (2007-2010) and after (2011-2020) introduction of the ISVMP. The primary outcome was interstage weight gain, and the secondary outcome was interstage growth failure. Multivariable linear and logistic regression models were used to examine the association between the Social Vulnerability Index and the outcomes. We introduced an interaction term into the models to test for effect modification by the ISVMP. We evaluated 217 ISVMP infants and 111 pre-ISVMP historical controls. The Social Vulnerability Index was associated with interstage growth failure (P=0.001); however, enrollment in the ISVMP strongly attenuated this association (P=0.04). Pre-ISVMP, as well as high- and middle-vulnerability infants gained 4 g/d less and were significantly more likely to experience growth failure than low-vulnerability infants (high versus low: adjusted odds ratio [aOR], 12.5 [95% CI, 2.5-62.2]; middle versus low: aOR, 7.8 [95% CI, 2.0-31.2]). After the introduction of the ISVMP, outcomes did not differ by Social Vulnerability Index tertile. Infants with middle and high Social Vulnerability Index scores who were enrolled in the ISVMP gained 4 g/d and 2 g/d more, respectively, than pre-ISVMP controls. Conclusions In infants with hypoplastic left heart syndrome, high social vulnerability is a risk factor for poor interstage weight gain. However, enrollment in the ISVMP significantly reduces growth disparities.
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Affiliation(s)
- Rachel J. Shustak
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jing Huang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics UnitThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Vicky Tam
- Cartographic Modeling LabUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Alyson Stagg
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Therese M. Giglia
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Chitra Ravishankar
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Laura Mercer‐Rosa
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - James P. Guevara
- Division of General Pediatrics, Department of Pediatrics, The Children’s Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Monique M. Gardner
- Division of Cardiac Critical Care Medicine, The Children’s Hospital of Philadelphia and Department of Anesthesiology and Critical CarePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
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15
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Ram Kumar S, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Adil Husain S, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for Centers Performing Pediatric Heart Surgery in the United States. World J Pediatr Congenit Heart Surg 2023; 14:642-679. [PMID: 37737602 DOI: 10.1177/21501351231190353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Robert D B Jaquiss
- Department of Surgery, UT-Southwestern, Children's Health, Dallas, TX, USA
| | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James D St Louis
- Department of Surgery, Inova Children's Hospital, Fairfax, VA, USA
| | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, CA, USA
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, VA, USA
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, CA, USA
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Vanderbilt, TN, USA
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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16
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Hjorth-Johansen E, Børøsund E, Moen A, Harmens A, Martinsen I, Wik G, Fredriksen BE, Eger SHW, Holmstrøm H. Heart OBServation app: development of a decision support tool for parents of infants with severe cardiac disease. Cardiol Young 2023; 33:1350-1358. [PMID: 35938297 DOI: 10.1017/s1047951122002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Many parents of infants with CHD find it difficult to recognise symptoms of deterioration in their children. Therefore, a personalised decision support application for parents has been developed. This application aims to increase parents' awareness of their infant's normal condition, help them assess signs of deterioration, decide who and when to contact health services, and what to report. The aim of this paper is to describe the concept and report results from a usability study. METHODS An interprofessional group developed a mobile application called the Heart OBServation app in close collaboration with parents using an iterative process. We performed a usability study consisting of semi-structured interviews of 10 families at discharge and after one month and arranged two focus group interviews with nurses caring for these families. A thematic framework analysis of the interviews explored the usability of features in the application. Usability was assessed twice using the System Usability Scale, and a user log was registered throughout the study. RESULTS The overall system usability score, 82.3 after discharge and 81.7 after one month, indicates good system usability. The features of Heart OBServation were perceived as useful to provide tailored information, increase awareness of the child's normal condition, and to guide parents in what to look for. To empower parents, an interactive discharge checklist was added. CONCLUSIONS The Heart OBServation demonstrated good usability and was well received by parents and nurses. Feasibility and benefits of this application in clinical practice will be investigated in further studies.
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Affiliation(s)
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Moen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anna Harmens
- South-Eastern Norway Regional Health Authority, Oslo, Norway
| | - Ingeborg Martinsen
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Gunnar Wik
- Department of Paediatric and Adolescent Medicine, Sorlandet Hospital, Kristiansand, Norway
| | | | - Siw H W Eger
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Norway
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17
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Hartman D, Ebenroth E, Farrell A. Utilizing technology to expand home monitoring to high-risk infants with CHD. Cardiol Young 2023; 33:1124-1128. [PMID: 35836381 DOI: 10.1017/s1047951122002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infants born with single ventricle physiology that require an aorto-pulmonary shunt are at high risk for sudden cardiac death, particularly during the interstage period between the first-stage palliation and the second-stage palliation. Home monitoring programs have decreased interstage mortality in the hypoplastic left heart syndrome population prompting programs to expand the home monitoring program to other high-risk populations. At our mid-sized program, we implemented the Locus Health home monitoring platform first in the hypoplastic left heart syndrome population, then expanding to the single ventricle shunt population. Interstage mortality for the hypoplastic left heart syndrome population after initiation of the home monitoring program went from 18% prior to 2009 to 7% as of the end of 2020 (n = 99), with 2.8% mortality from 2013 to 2020 and 0% mortality since initiation of the Locus program in 2017. Caregiver surveys done prior to discharge and then 3 weeks later were used to document caregiver experience using the digital home monitoring program. Caregivers reported overall positive experience with the digital application, with 91.8% stating that they felt confident taking care of their baby at home. Transitioning the home monitoring program from a traditional binder to an iPad with the Locus Health application allowed us to expand the program, utilize the electronic medical record, bill for the service, and demonstrate positive experiences for caregivers. Overall engagement and adherence with the program by caregivers were 50.94 and 45.45%, with a total of 112 patient episodes. Reimbursement from private insurance providers was 22% of the billed amount for 2020.
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Affiliation(s)
- Dana Hartman
- Riley Hospital for Children at Indiana University Health, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, USA
| | - Eric Ebenroth
- Indiana University School of Medicine, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, Indiana, USA
| | - Anne Farrell
- Riley Hospital for Children at Indiana University Health, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, USA
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18
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Tandon A, Nguyen HH, Avula S, Seshadri DR, Patel A, Fares M, Baloglu O, Amdani S, Jafari R, Inan OT, Drummond CK. Wearable Biosensors in Congenital Heart Disease: Needs to Advance the Field. JACC. ADVANCES 2023; 2:100267. [PMID: 37152621 PMCID: PMC10162770 DOI: 10.1016/j.jacadv.2023.100267] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 05/09/2023]
Abstract
Traditional measures of clinical status and physiology have generally been based in health care settings, episodic, short in duration, and performed at rest. Wearable biosensors provide an opportunity to obtain continuous non-invasive physiologic data from patients with congenital heart disease (CHD) in the real-world setting, over longer durations, and across varying levels of activity. However, there are significant technical limitations to the use of wearable biosensors in CHD. Here, we review current applications of wearable biosensors in CHD; how clinical and research uses of wearable biosensors must consider various CHD physiologies; the technical challenges in developing wearable biosensors for CHD; and special considerations for digital biomarkers in CHD.
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Affiliation(s)
- Animesh Tandon
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Cleveland Clinic Children's Center for Artificial Intelligence (C4AI), Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case School of Engineering at Case Western Reserve University, Cleveland, Ohio, USA
| | - Hoang H. Nguyen
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sravani Avula
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dhruv R. Seshadri
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Akash Patel
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Munes Fares
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Orkun Baloglu
- Cleveland Clinic Children's Center for Artificial Intelligence (C4AI), Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Department of Critical Care, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Cleveland Clinic Children's Center for Artificial Intelligence (C4AI), Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Roozbeh Jafari
- Departments of Biomedical Engineering, Computer Science and Electrical Engineering, Texas A&M University, College Station, Texas, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Colin K. Drummond
- Department of Biomedical Engineering, Case School of Engineering at Case Western Reserve University, Cleveland, Ohio, USA
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19
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Lisanti AJ, Golfenshtein N, Min J, Medoff-Cooper B. Early growth trajectory is associated with psychological stress in parents of infants with congenital heart disease, but moderated by quality of partner relationship. J Pediatr Nurs 2023; 69:93-100. [PMID: 36696826 PMCID: PMC10106376 DOI: 10.1016/j.pedn.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To explore the relationships between growth trajectory, parenting stress and parent post-traumatic stress (PTS), in infants with congenital heart disease, and the moderating role of parents' dyadic adjustment on those associations. DESIGN AND METHODS A secondary analysis of data from the REACH Telehalth home monitoring multi-site randomized clinical trial. Parents completed the Parenting Stress Index (PSI), Post-traumatic diagnostic scale, and the Dyadic Adjustment Scale. Multivariate logistic regression models were used to examine the associations of interest. RESULTS During 4-month follow-up after hospital discharge, parents of infants with 'Never recovered' and 'Partially recovered' growth trajectories had 2-5 times higher odds of experiencing higher stress on the Parent Domain (OR = 4.8, CI = 1.3-18.0; OR = 2.5, CI = 1.0-5.9, respectively) than those with stably grown infants. Parents of "Never recovered" infants had 4 times higher odds of PTS symptoms (OR = 3.9; CI = 1.6-9.9). Parental dyadic adjustment moderated the relationships. Parents of 'Partially recovered' infants and having low dyadic adjustment had 3-5 times higher odds of high stress on all PSI domains, while parents with high dyadic adjustment did not have increased stress due to poor infant growth. Parents of "Never recovered" infants had four times higher odds of PTS symptom, even with high dyadic adjustment. CONCLUSIONS Infant growth trajectory over the first four months is associated with parenting stress and PTS. Quality of partner relationship moderates some of these associations. PRACTICE IMPLICATIONS Infant growth should serve as a screening aid for identifying parents at psychological risk. Interventions targeting the quality of partner relationship may support parental coping and mitigate stress. CLINICAL TRIAL REGISTRATION NCT01941667.
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Affiliation(s)
- Amy Jo Lisanti
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States of America; Research Institute, Children's Hospital of Philadelphia, United States of America.
| | - Nadya Golfenshtein
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States of America; University of Haifa, Department of Nursing, Israel
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Research Institute, Children's Hospital of Philadelphia, United States of America
| | - Barbara Medoff-Cooper
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States of America; Research Institute, Children's Hospital of Philadelphia, United States of America
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20
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Gabapentin Can Improve Irritability and Feeding Tolerance in Single Ventricle Interstage Patients: A Case Series. Pediatr Cardiol 2023; 44:487-493. [PMID: 36131139 DOI: 10.1007/s00246-022-03009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
Visceral hyperalgesia is common among children with complex medical conditions. Infants with complex congenital heart disease, specifically single ventricle interstage patients, are often found to have feeding intolerance and irritability. Gabapentin treatment has shown promise for symptomatic improvement for visceral hyperalgesia in some patients. We present a case series of five patients in which four of the five patients showed improvement within 48 h of starting gabapentin. The use of gabapentin in single ventricle interstage patients to treat visceral hyperalgesia shows promise based on our case series, but future multi-center prospective studies would be beneficial.
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21
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Huisenga D, la Bastide-van Gemert S, Van Bergen AH, Sweeney JK, Hadders-Algra M. Motor development in infants with complex congenital heart disease: A longitudinal study. Dev Med Child Neurol 2023; 65:117-125. [PMID: 35665492 PMCID: PMC10084079 DOI: 10.1111/dmcn.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/31/2022]
Abstract
AIM To evaluate whether infants with complex congenital heart disease (CCHD) have an increased risk of impaired quality of motor behavior and delayed motor milestones. METHOD A cohort of 69 infants with CCHD (43 males, 26 females) were assessed with the Infant Motor Profile (IMP) at three time periods between 6 to 18 months, mean ages in months (SD): 6.4 (0.7); 12.7 (1.0); 18.5 (0.7) IMP data were available from a reference sample of 300 Dutch infants. Analyses included multivariable logistic regression analysis to estimate differences in IMP scores below the 15th centile between children with CCHD and the reference group, and linear mixed-effects models to assess the effect of ventricular physiology and systemic oxygen saturation (SpO2) of less than 90% on IMP outcomes. RESULTS Infants with CCHD had increased risks of total IMP scores below the 15th centile (lowest odds ratio [OR] at 18mo: 6.82 [95% confidence interval {CI} 2.87-16.19]), especially because of lower scores in the domains of variation, adaptability, and performance. Children with single ventricle CCHD scored consistently 3.03% (95% CI 1.00-5.07) lower than those with two ventricle physiology, mainly from contributions of the variation and performance domains. SpO2 of less than 90% was associated with 2.52% (95% CI 0.49-4.54) lower IMP scores. INTERPRETATION CCHD, especially single ventricle physiology, increases risk of impaired motor development. WHAT THIS PAPER ADDS Complex congenital heart disease (CCHD) substantially increases risk of impaired motor development. CCHD is associated with motor delay and reduced motor variation and adaptability. Single ventricle physiology increases the risk of impaired motor behavior.
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Affiliation(s)
- Darlene Huisenga
- Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, Illinois, USA.,University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Sacha la Bastide-van Gemert
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Andrew H Van Bergen
- Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, Illinois, USA.,Advocate Children's Hospital, Advocate Children's Heart Institute, Division of Pediatric Cardiac Critical Care, Oak Lawn, Illinois, USA
| | - Jane K Sweeney
- Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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22
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Bouyaala Y, Bindermann R, Wendt S, Kroener A, Bennink G, Sreeram N. Indications for and outcomes of interstage catheter interventions following the Norwood procedure: A single-institution study. Ann Pediatr Cardiol 2023; 16:25-31. [PMID: 37287842 PMCID: PMC10243655 DOI: 10.4103/apc.apc_125_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 06/09/2023] Open
Abstract
Aims The aim of this study was to document the incidence, types, and outcome of interstage catheter interventions following the Norwood surgical palliation. Patients and Methods A retrospective single-center study of all patients surviving the Norwood operation was performed. All data concerning interstage catheter interventions up to the completion of the superior cavopulmonary shunt were collected. Results Catheter interventions were performed in 62 of 94 patients (66%; 38 males). These included interventions on the aortic arch (n = 44), the branch pulmonary arteries (PAs) (n = 17), and the Sano shunt (n = 14). Multiple interventions and repeat interventions were common. The minimum aortic arch diameter (pre- versus posttreatment) increased from median 3.1 (2.3-3.3) mm to 5.1 (4.2-6.2) mm (P < 0.001). The catheter pullback gradient decreased from 40 (36-46) mmHg to 9 (5-10) mmHg (P < 0.001), and the echocardiographic gradient from 54 (45-64) mmHg to 12 (10-16) mmHg (P < 0.001). The branch PA diameters increased from 2.4 (2.1-3.0) mmHg to 4.7 (4.2-5.1) mmHg (P < 0.001). The minimum Sano shunt diameters increased from 2.0 (1.5-2.1) mm to 5.9 (5.8-6.0) mm (P < 0.001); this was associated with an improvement in systemic saturation from 63% (60%-65%) to 80% (79-82%) (P < 0.001). Unexpected interstage death at home occurred in two patients who had received no interventions. The remainder received a superior cavopulmonary shunt palliation. Conclusions Catheter interventions were common. Systematic follow-up and a low threshold for reintervention are essential to the success of staged surgical palliation for this patient cohort.
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Affiliation(s)
- Yousra Bouyaala
- Heart Center, University Hospital of Cologne, Cologne, Germany
| | | | - Stefanie Wendt
- Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Axel Kroener
- Heart Center, University Hospital of Cologne, Cologne, Germany
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23
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Stagg A, Giglia TM, Gardner MM, Offit BF, Fuller KM, Natarajan SS, Hehir DA, Szwast AL, Rome JJ, Ravishankar C, Laskin BL, Preminger TJ. Initial Experience with Telemedicine for Interstage Monitoring in Infants with Palliated Congenital Heart Disease. Pediatr Cardiol 2023; 44:196-203. [PMID: 36050411 PMCID: PMC9436461 DOI: 10.1007/s00246-022-02993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality; home monitoring programs have mitigated these risks. In 2019, we instituted telemedicine (TM) in our established Infant Single Ventricle Monitoring Program. All consecutive patients discharged following neonatal operation/intervention were monitored until subsequent stage 2 surgical palliation. We offered TM (synchronous video) visits as part of regularly scheduled follow-up, replacing at least one in-person primary care visit with a TM cardiologist visit. We tracked emergency department (ED) visits, hospitalizations, how TM identified clinical concerns, and whether use of TM prevented unnecessary ED visits or expedited in-person assessment. We assessed caregiver and clinician satisfaction. Between 8/2019 and 5/2020, we conducted 60 TM visits for 29 patients. Of 31 eligible patients, 2 families (6.9%) declined. Median monitoring time was 199 days (range 75-264) and median number of TM visits/patient was 2 (range 1-5). In 6 visits (10%), significant clinical findings were identified which avoided an ED visit. Five TM visits led to expedited outpatient assessments, of which 1 patient required hospitalization. There were no missed events or deaths. Median ED visits/patient/month were significantly lower compared to the same calendar period of the prior year (0.0 (0-2.5) vs. 0.4 (0-3.7), p = 0.0004). Caregivers and clinicians expressed high levels of satisfaction with TM. TM for this high-risk population is feasible and effective in identifying clinical concerns and preventing unnecessary ED visits. TM was particularly effective during the COVID-19 pandemic, allowing for easy adaptation of care to ensure patient safety in this fragile cohort.
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Affiliation(s)
- Alyson Stagg
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Therese M Giglia
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique M Gardner
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bonnie F Offit
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
| | - Kate M Fuller
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
| | - Shobha S Natarajan
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Hehir
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anita L Szwast
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan J Rome
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chitra Ravishankar
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin L Laskin
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tamar J Preminger
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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24
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Meakins LT, Knox P, Legge L, Penner M, Wiebe P, Mackie AS. Interstage mortality among infants with hypoplastic left heart syndrome: Outcomes of a multicentre home monitoring program. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101610] [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: 12/23/2022]
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25
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Brown KL, Huang Q, Hadjicosta E, Seale AN, Tsang V, Anderson D, Barron D, Bellsham-Revell H, Pagel C, Crowe S, Espuny-Pujol F, Franklin R, Ridout D. Long-term survival and center volume for functionally single-ventricle congenital heart disease in England and Wales. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01259-4. [PMID: 36535820 DOI: 10.1016/j.jtcvs.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Long-term survival is an important metric for health care evaluation, especially in functionally single-ventricle (f-SV) congenital heart disease (CHD). This study's aim was to evaluate the relationship between center volume and long-term survival in f-SV CHD within the centralized health care service of England and Wales. METHODS This was a retrospective cohort study of children born with f-SV CHD between 2000 and 2018, using the national CHD procedure registry, with survival ascertained in 2020. RESULTS Of 56,039 patients, 3293 (5.9%) had f-SV CHD. Median age at first intervention was 7 days (interquartile range [IQR], 4, 27), and median follow-up time was 7.6 years (IQR, 1.0, 13.3). The largest diagnostic subcategories were hypoplastic left heart syndrome, 1276 (38.8%); tricuspid atresia, 440 (13.4%); and double-inlet left ventricle, 322 (9.8%). The survival rate at 1 year and 5 years was 76.8% (95% confidence interval [CI], 75.3%-78.2%) and 72.1% (95% CI, 70.6%-73.7%), respectively. The unadjusted hazard ratio for each 5 additional patients with f-SV starting treatment per center per year was 1.04 (95% CI, 1.02-1.06), P < .001. However, after adjustment for significant risk factors (diagnostic subcategory; antenatal diagnosis; younger age, low weight, acquired comorbidity, increased severity of illness at first procedure), the hazard ratio for f-SV center volume was 1.01 (95% CI, 0.99-1.04) P = .28. There was strong evidence that patients with more complex f-SV (hypoplastic left heart syndrome, Norwood pathway) were treated at centers with greater f-SV case volume (P < .001). CONCLUSIONS After adjustment for case mix, there was no evidence that f-SV center volume was linked to longer-term survival in the centralized health service provided by the 10 children's cardiac centers in England and Wales.
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Affiliation(s)
- Kate L Brown
- Great Ormond Street Hospital Biomedical Research Centre and Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Qi Huang
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Elena Hadjicosta
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Anna N Seale
- Paediatric Cardiology and Cardiothoracic Surgery, Birmingham Women's and Children's Hospital National Health Service Foundation Trust and Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | - Victor Tsang
- Great Ormond Street Hospital Biomedical Research Centre and Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - David Anderson
- Paediatric Cardiology, Evelina London Hospital, London, United Kingdom
| | - David Barron
- Paediatric Cardiology and Cardiothoracic Surgery, Birmingham Women's and Children's Hospital National Health Service Foundation Trust and Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | | | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Sonya Crowe
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Ferran Espuny-Pujol
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Rodney Franklin
- Paediatric Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Deborah Ridout
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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26
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Vergales J, Figueroa M, Frommelt M, Putschoegl A, Singh Y, Murray P, Wood G, Allen K, Villafane J. Transitioning Neonates With CHD to Outpatient Care: A State-of-the-Art Review. Pediatrics 2022; 150:189880. [PMID: 36317969 DOI: 10.1542/peds.2022-056415m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jeffrey Vergales
- Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia
| | - Mayte Figueroa
- Divisions of Pediatric Cardiology and Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michele Frommelt
- Children's Wisconsin, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adam Putschoegl
- Division of Pediatric Cardiology, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Yogen Singh
- Division of Pediatric Cardiology and Neonatology, Cambridge University Hospitals, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Peter Murray
- Division of Neonatology, University of Virginia, Charlottesville, Virginia
| | - Garrison Wood
- Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia
| | - Kiona Allen
- Division of Pediatric Cardiology and Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Juan Villafane
- Cincinnati Children's Hospital, Division of Pediatric Cardiology, University of Cincinnati, Cincinnati, Ohio
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27
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Sengupta A, Gauvreau K, Bucholz EM, Newburger JW, Del Nido PJ, Nathan M. Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery. Circulation 2022; 146:1284-1296. [PMID: 36164982 DOI: 10.1161/circulationaha.122.060030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND While singular measures of socioeconomic status have been associated with outcomes after surgery for congenital heart disease, the multifaceted pathways through which a child's environment impacts similar outcomes remain incompletely characterized. We sought to evaluate the association between childhood opportunity level and adverse outcomes after congenital heart surgery. METHODS Data from patients undergoing congenital cardiac surgery from January 2011 to January 2020 at a quaternary referral center were retrospectively reviewed. Outcomes of interest included predischarge (early) mortality or transplant, postoperative hospital length-of-stay, inpatient cost of hospitalization, postdischarge (late) mortality or transplant, and late unplanned reintervention. The primary predictor was a US census tract-based, nationally-normed composite metric of contemporary child neighborhood opportunity comprising 29 indicators across 3 domains (education, health and environment, and socioeconomic), categorized as very low, low, moderate, high, and very high. Associations between childhood opportunity level and outcomes were evaluated using logistic regression (early mortality), generalized linear (length-of-stay and cost), Cox proportional hazards (late mortality), or competing risk (late reintervention) models, adjusting for baseline patient-related factors, case complexity, and residual lesion severity. RESULTS Of 6133 patients meeting entry criteria, the median age was 2.0 years (interquartile range, 3.6 months-8.3 years). There were 124 (2.0%) early deaths or transplants, the median postoperative length-of-stay was 7 days (interquartile range, 5-13 days), and the median inpatient cost was $76 000 (interquartile range, $50 000-130 000). No significant association between childhood opportunity level and early mortality or transplant was observed (P=0.21). On multivariable analysis, children with very low and low opportunity had significantly longer length-of-stay and incurred higher costs compared with those with very high opportunity (all P<0.05). Of 6009 transplant-free survivors of hospital discharge, there were 175 (2.9%) late deaths or transplants, and 1008 (16.8%) reinterventions at up to 10.5 years of follow-up. Patients with very low opportunity had a significantly greater adjusted risk of late death or transplant (hazard ratio, 1.7 [95% CI, 1.1-2.6]; P=0.030) and reintervention (subdistribution hazard ratio, 1.9 [95% CI, 1.5-2.3]; P<0.001), versus those with very high opportunity. CONCLUSIONS Childhood opportunity level is independently associated with adverse outcomes after congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.
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Affiliation(s)
- Aditya Sengupta
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA
| | - Kimberlee Gauvreau
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA.,Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.G.)
| | - Emily M Bucholz
- Cardiology (K.G., E.M.B., J.W.N.), Boston Children's Hospital, MA
| | - Jane W Newburger
- Cardiology (K.G., E.M.B., J.W.N.), Boston Children's Hospital, MA.,Departments of Pediatrics (J.W.N.), Harvard Medical School, Boston, MA
| | - Pedro J Del Nido
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA.,Surgery (P.J.dN., M.N.), Harvard Medical School, Boston, MA
| | - Meena Nathan
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA.,Surgery (P.J.dN., M.N.), Harvard Medical School, Boston, MA
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28
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Preminger TJ. Telemedicine in pediatric cardiology: pros and cons. Curr Opin Pediatr 2022; 34:484-490. [PMID: 35983842 DOI: 10.1097/mop.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review recent uses of telemedicine in pediatric cardiology, highlighting merits, challenges, and future directions. RECENT FINDINGS The COVID-19 pandemic accelerated telemedicine use, which has had a positive impact with respect to providers, patients, and their caregivers. Recent data have demonstrated the feasibility and effectiveness of telemedicine through expediting needed care and reducing healthcare utilization, including unnecessary emergency department visits, transports, and hospitalizations. With increasing complexity of cardiac care, telecardiology allows for establishing a medical home, improving access, and continuity of care. Great potential also exists for telecardiology to permit more consistent preventive care, possibly resulting in improved health equity, reduced morbidity and mortality, and associated costs. Challenges to optimal implementation of telecardiology, which are all surmountable, include the currently unaccounted additional workload and administrative burden, licensing restrictions, disparities in access to care, insurance reimbursement, and potential fraud and abuse. SUMMARY Telecardiology allows for efficient, quality, effective, collaborative care and is foundational to creating innovative, high-value care models. Through integration with accelerating technology and in-person visits, a sustainable hybrid model of optimal care can be achieved. Addressing barriers to progress in telecardiology is critical.
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Affiliation(s)
- Tamar J Preminger
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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29
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Abstract
IMPORTANCE Single ventricle CHD affects about 5 out of 100,000 newborns, resulting in complex anatomy often requiring multiple, staged palliative surgeries. Paediatricians are an essential part of the team that cares for children with single ventricle CHD. These patients often encounter their paediatrician first when a complication arises, so it is critical to ensure the paediatrician is knowledgeable of these issues to provide optimal care. OBSERVATIONS We reviewed the subtypes of single ventricle heart disease and the various palliative surgeries these patients undergo. We then searched the literature to detail the general paediatrician's approach to single ventricle patients at different stages of surgical palliation. CONCLUSIONS AND RELEVANCE Single ventricle patients undergo staged palliation that drastically changes physiology after each intervention. Coordinated care between their paediatrician and cardiologist is requisite to provide excellent care. This review highlights what to expect when these patients are seen by their paediatrician for either well child visits or additional visits for parental or patient concern.
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30
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Genna C, Thekkan KR, Geremia C, Di Furia M, Campana A, Dall'Oglio I, Tiozzo E, Gawronski O. Parents' process of recognition and response to clinical deterioration of their children with medical complexity at home: A grounded theory. J Clin Nurs 2022. [PMID: 36101491 DOI: 10.1111/jocn.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
AIM To explore the process of recognition and response to clinical deterioration of children with medical complexity at home by their parents. BACKGROUND Children with medical complexity are characterised by known chronic conditions associated with frailty and functional limitations, dependence on healthcare services and high use of technology and resources. Their medical complexity often leads to the onset of complications. Targeted care ensures timely recognition and response to clinical deterioration at home, thus avoiding serious sequelae, inappropriate hospitalisations and improving quality of life. Evidence on parents' process of the recognition and response to clinical deterioration at home is limited. DESIGN Qualitative study using a Grounded Theory methodology. METHOD Seven online focus groups were conducted with parents and healthcare providers experienced in their care. The interviews were transcribed verbatim and analysed through open, axial and selective coding, using a constant comparative iterative method. The COREQ guidelines guided the reporting of this work. RESULTS Four categories and one core category were identified: (1) Awareness of the unique and shared characteristics of children with medical complexity; (2) Parents' care maintenance and management; (3) Parents' care monitoring; (4) Parents' response to clinical deterioration and (5) Seeking the Shift of Agency, the core category as the foundation of the Process of Recognition and rEsponse of PAREnts to Deterioration (PRE-PARE-D) theory. CONCLUSION The role of parents of children with medical complexity is evolving into active care leaders, by developing care management and care monitoring competences and negotiating care with healthcare providers. RELEVANCE TO CLINICAL PRACTICE The shift of agency from healthcare providers to parents requires education and counselling pathways to promote the development of parent's self-efficacy, competencies and empowerment in the care management of their children. Home care delivery for children with medical complexity should aim at sustaining this partnership between healthcare providers and parents.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesiology and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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31
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Edwin F, Edwin AK, Palacios-Macedo A, Mamorare H, Yao NA. Management of Hypoplastic Left Heart Syndrome in Low-Resource Settings and the Ethics of Decision-Making. World J Pediatr Congenit Heart Surg 2022; 13:609-614. [PMID: 36053092 DOI: 10.1177/21501351221103511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is possibly the most challenging congenital heart defect to confront in any setting. The highly specialized infrastructure and resources needed to treat HLHS is not available in many low-resource settings. However, low-resource settings must not be assumed to be synonymous with low- and middle-income countries as national income is not necessarily indicative of a country's prioritization of healthcare resources. Besides, a low-resource setting may be institution-specific as well as country-specific. We have stratified institutional capabilities for addressing the requirements of treatment for HLHS into five levels based on the capacity for diagnosis, intervention, and post-discharge monitoring. Depending on institutional capabilities, children born with HLHS in low-resource settings experience a spectrum of outcomes ranging from death without diagnosis to the hybrid or Norwood stage 1 palliation. The decision-making is ethically challenging when resources are scarce and economic efficiency must be considered in the context of distributive justice. Even in settings that would be classified as resource-rich where survival after surgery and quality of life afterward keep improving, not every parent would choose surgical intervention for their hypothetical child with HLHS.
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Affiliation(s)
- Frank Edwin
- Ho Cardiothoracic Centre, School of Medicine, University of Health & Allied Sciences, Ho, Ghana
- National Cardiothoracic Centre, Accra, Ghana
| | - Ama K Edwin
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Department of Bioethics and Palliative Care, University of Ghana Medical Centre, Accra, Ghana
| | - Alexis Palacios-Macedo
- Division de Cirugıa Cardiovasclar, 37759Instituto Nacional de Pediatria, Mexico City, Mexico
- Centro Pediatrico del Corazon ABC-Kardias, Mexico City, Mexico
| | | | - Nana Akyaa Yao
- National Cardiothoracic Centre, Accra, Ghana
- Department of Pediatric Cardiology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Broberg MCG, Cheifetz IM, Plummer ST. Current evidence for pharmacologic therapy following stage 1 palliation for single ventricle congenital heart disease. Expert Rev Cardiovasc Ther 2022; 20:627-636. [PMID: 35848073 DOI: 10.1080/14779072.2022.2103542] [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: 10/17/2022]
Abstract
INTRODUCTION Infants with single ventricle congenital heart disease are vulnerable to complications between stage 1 and stage 2 of palliation. Pharmaceutical treatment during this period is varied and often dependent on institutional practices as there is little evidence supporting a particular treatment path. AREAS COVERED This review focuses on medical management of patients following stage I palliation. We performed a scoping review of the current literature regarding angiotensin converting enzyme inhibitors and digoxin treatment in the interstage period. In addition, we discuss other medication classes frequently used in these patients. EXPERT OPINION Due to significant heterogeneity of anatomy, rarity of disease, and other confounding factors, there is limited evidence to support most commonly used medications within the interstage period. Digoxin is associated with improved mortality within the interstage period and should be considered; however, no large randomized controlled trial exists supporting its use. Prevention of thrombotic complication with aspirin is also associated with improved outcomes and should be considered unless a contraindication exists. The addition of other prescriptions in this patient population should be considered only after an evaluation of the risks and benefits of each medication, recognizing the burden and risk of polypharmacy in this fragile patient population.
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Affiliation(s)
- Meredith C G Broberg
- Department of Pediatrics, Division of Pediatric Cardiac Critical Care, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ira M Cheifetz
- Department of Pediatrics, Division of Pediatric Cardiac Critical Care, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Department of Pediatrics, Division of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sarah T Plummer
- Department of Pediatrics, Division of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Imperial-Perez F, Pike NA, Doering LV, Eastwood JA, Heilemann MV. Caregiving for Interstage Infants: A Continuous Process of Compromise During the Pandemic. World J Pediatr Congenit Heart Surg 2022; 13:443-450. [PMID: 35585726 PMCID: PMC9121143 DOI: 10.1177/21501351221099945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Infants born with single ventricle heart disease require
in-home medicalized care during the interstage period (time between the first
and second staged heart surgery). These caregivers rely on extended family,
friends, and hired caretakers to provide respite time. However, the coronavirus
pandemic removed these families’ options due to stay-at-home and social
distancing directives. We explored the caregivers’ experiences during the
interstage period, including impacts on their lifestyle, as they managed their
infants’ critical needs during the coronavirus disease 2019 pandemic.
Method: In-person or telephonic interviews of 14 caregivers
interviewed once or twice were conducted between November 2019 and July 2020.
Constructivist Grounded Theory methodology guided both data collection and
analysis for the inductive and abductive exploration of caregivers’ experiences.
Results: Data analysis led to the development of 2 concepts:
Accepting and adapting to a restrictive home environment
and Reconciling what is and what is yet to come. Refinement of
the relationship between the 2 concepts led to the development of a theory
grounded in the words and experiences of the participants called: A
Continuous Process of Compromise. Conclusions: Our
findings increase understanding of caregivers’ experiences related to
psychosocial and lifestyle impacts and the need for additional support during
the interstage period.
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Affiliation(s)
- Flerida Imperial-Perez
- 5150Children's Hospital Los Angeles, Heart Institute, Section of Cardiothoracic ICU, Los Angeles, CA, USA.,8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Nancy A Pike
- 5150Children's Hospital Los Angeles, Heart Institute, Section of Cardiothoracic ICU, Los Angeles, CA, USA.,8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Lynn V Doering
- 8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Jo-Ann Eastwood
- 8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - MarySue V Heilemann
- 8783University of California Los Angeles School of Nursing, Los Angeles, CA, USA
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Jackson SR, Chowdhury SM, Woodard FK, Zyblewski SC. Factors associated with caregiver adherence to mobile health interstage home monitoring in infants with single ventricle or biventricular shunt-dependent heart disease. Cardiol Young 2022; 33:1-6. [PMID: 35673790 PMCID: PMC9729388 DOI: 10.1017/s1047951122001822] [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] [Indexed: 11/05/2022]
Abstract
Mobile health technology is an emerging tool in interstage home monitoring for infants with single ventricle heart disease or biventricular shunt-dependent defects. This study sought to describe adherence to mobile health monitoring and identify factors and outcomes associated with adherence to mobile health monitoring. This was a retrospective, single-institution study of infants who were followed in a mobile health-based interstage home monitoring programme between February 2016 and October 2020. The analysis included 105 infants and subjects were grouped by frequency of adherence to mobile health monitoring. Within the study cohort, 16 (15.2%) had 0% adherence, 25 (23.8%) had <50% adherence, and 64 (61.0%) had >50% adherence. The adherent groups had a higher percentage of infants who were male (p = 0.02), white race (p < 0.01), non-Hispanic or non-Latinx ethnicity (p < 0.01) and had mothers with primary English fluency (p < 0.01), married marital status (p < 0.01), and a prenatal diagnosis of faetal cardiac disease (p = 0.03). Adherent groups also had a higher percentage of infants with non-Medicaid primary insurance (p < 0.01) and residence in a neighbourhood with a higher median household income (p < 0.04). Frequency of adherence was not associated with interstage mortality, unplanned cardiac reinterventions, or hospital readmissions. Impact of mobile health interstage home monitoring on caregiver stress as well as use of multi-language, low literacy, affordable mobile health options for interstage home monitoring warrant further investigation.
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Affiliation(s)
- Sydney R. Jackson
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Frances K. Woodard
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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Kumar KR, Flair A, Thompson EJ, Zimmerman KO, Andersen ND, Hill KD, Hornik CP. Association Between Digoxin Use and Cardiac Function in Infants With Single-Ventricle Congenital Heart Disease During the Interstage Period. Pediatr Crit Care Med 2022; 23:453-463. [PMID: 35404313 PMCID: PMC9203926 DOI: 10.1097/pcc.0000000000002946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the association between digoxin use and cardiac function assessed by echocardiographic indices in infants with single-ventricle (SV) congenital heart disease (CHD) during the interstage period. DESIGN Retrospective cohort study. SETTING Fifteen North American hospitals. PATIENTS Infants discharged home following stage 1 palliation (S1P) and prior to stage 2 palliation (S2P). Infants with no post-S1P and pre-S2P echocardiograms were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 373 eligible infants who met inclusion criteria, 140 (37.5%) were discharged home on digoxin. In multivariable linear and logistic regressions, we found that compared with infants discharged home without digoxin, those discharged with digoxin had a smaller increase in end-systolic volume (β = -8.17 [95% CI, -15.59 to -0.74]; p = 0.03) and area (β = -1.27 [-2.45 to -0.09]; p = 0.04), as well as a smaller decrease in ejection fraction (β = 3.38 [0.47-6.29]; p = 0.02) and fractional area change (β = 2.27 [0.14-4.41]; p = 0.04) during the interstage period. CONCLUSIONS Digoxin may partially mitigate the expected decrease in cardiac function during the interstage period through its positive inotropic effects. Prospective clinical trials are needed to establish the pharmacokinetics, safety, and efficacy of digoxin use in SV CHD.
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Affiliation(s)
- Karan R. Kumar
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Antonina Flair
- Duke Clinical Research Institute, Durham, North Carolina
| | - Elizabeth J. Thompson
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | | | - Kevin D. Hill
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
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Surgical Strategies in Single Ventricle Management of Neonates and Infants. Can J Cardiol 2022; 38:909-920. [PMID: 35513174 DOI: 10.1016/j.cjca.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/17/2022] Open
Abstract
No area of congenital heart disease has undergone greater change and innovation than Single Ventricle management over the past 20 years. Surgical and catheter lab interventions have transformed outcomes such that in some subgroups more than 80% of these patients can survive into adulthood. Driven by parallel development in diagnostic imaging and cardiac intensive care, surgical management is focused on the neonatal period as the key time to creating a balanced circulation and limiting pulmonary blood-flow. Different configurations of the circulation including new types of surgical shunts and the role of 'hybrid' circulations provide greater options and better physiology. This overview will focus on these changes in surgical management and timing but also look at the exciting areas of regenerative therapies to improve ventricular function, and the concept of ventricular rehabilitation to achieve biventricular circulations in certain groups of patients. The importance of early (neonatal) intervention and multidisciplinary approach to management is emphasised, as well as looking beyond simply survival but also improving neurodevelopmental outcomes.
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Lopez KN, Baker-Smith C, Flores G, Gurvitz M, Karamlou T, Nunez Gallegos F, Pasquali S, Patel A, Peterson JK, Salemi JL, Yancy C, Peyvandi S. Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025358. [PMID: 35389228 PMCID: PMC9238447 DOI: 10.1161/jaha.122.025358] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the overall improvement in life expectancy of patients living with congenital heart disease (congenital HD), disparities in morbidity and mortality remain throughout the lifespan. Longstanding systemic inequities, disparities in the social determinants of health, and the inability to obtain quality lifelong care contribute to poorer outcomes. To work toward health equity in populations with congenital HD, we must recognize the existence and strategize the elimination of inequities in overall congenital HD morbidity and mortality, disparate health care access, and overall quality of health services in the context of varying social determinants of health, systemic inequities, and structural racism. This requires critically examining multilevel contributions that continue to facilitate health inequities in the natural history and consequences of congenital HD. In this scientific statement, we focus on population, systemic, institutional, and individual‐level contributions to health inequities from prenatal to adult congenital HD care. We review opportunities and strategies for improvement in lifelong congenital HD care based on current public health and scientific evidence, surgical data, experiences from other patient populations, and recognition of implicit bias and microaggressions. Furthermore, we review directions and goals for both quantitative and qualitative research approaches to understanding and mitigating health inequities in congenital HD care. Finally, we assess ways to improve the diversity of the congenital HD workforce as well as ethical guidance on addressing social determinants of health in the context of clinical care and research.
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Pridham K, Melby J, Connor A, Brown R, Nemykina Y. Parents' Interactive Problem-Solving Behavior and Emotion Studied With Audio Compared With Video Source. Res Theory Nurs Pract 2022; 36:RTNP-2022-0001. [PMID: 35292561 PMCID: PMC9475443 DOI: 10.1891/rtnp-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Parents' communication and problem-solving interaction with each other and with clinicians influences the caregiving of infants with a chronic health problem, making in-depth study of this interaction critical for design of interventions to support caregiving. This study, however, has been severely limited by lack of observational methods that can be applied in home, clinic and community settings. The Iowa Family Interaction Rating Scales provide comprehensive description of communicative and problem-solving behavior and emotion, but have only been applied to video-recorded interaction. Audio recording, in contrast to video recording, has the advantage of being unobtrusive, readily accessible, and generally acceptable, increasing the opportunity for focused examination and intervention of parents' interaction with each other or with clinicians. Our study objective was to examine the agreement of scores obtained on parents' interactive problem-solving behavior coded with the Iowa Family Interaction Rating Scales using an audio-recorded source for coding compared with coding from a video-recorded source. METHOD In secondary analysis, audio-recordings were derived from video recordings of 15 parent-parent interactions. Audio recordings were created and coded blind of the original video recording and coding. RESULTS Using Gwet's AC1 coefficient, agreement was at least moderate (0.61 - 0.80) for 69.1% of paired codes, signifying reliability of coding from audio recording for most codes. IMPLICATIONS FOR PRACTICE Selected Iowa Family Interaction Rating Scales can be used with acceptable reliability for coding parents' interactive problem-solving behavior from audio source, advancing the study of parent interactive-problem solving behavior and potentially parents' problem solving with clinicians.
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Affiliation(s)
- Karen Pridham
- University of Wisconsin-Madison School of Nursing, Madison, WI
| | | | | | - Roger Brown
- University of Wisconsin-Madison School of Nursing, Madison, WI
| | - Yuliya Nemykina
- University of Wisconsin-Madison School of Nursing, Madison, WI
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39
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Developing a sense of self-reliance: caregivers of infants with single-ventricle heart disease during the interstage period. Cardiol Young 2022; 32:465-471. [PMID: 34162456 DOI: 10.1017/s1047951121002407] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Caring for infants after the first-stage palliative surgery for single-ventricle heart disease bring challenges beyond the usual parenting responsibilities. Current studies fail to capture the nuances of caregivers' experiences during the most critical "interstage" period between the first and second surgery. OBJECTIVES To explore the perceptions of caregivers about their experiences while transitioning to caregiver roles, including the successes and challenges associated with caregiving during the interstage period. METHODS Constructivist Grounded Theory methodology guided the collection and analysis of data from in person or telephonic interviews with caregivers after their infants underwent the first-stage palliative surgery for single-ventricle heart disease, and were sent to home for 2-4 months before returning for their second surgery. Symbolic interactionism informed data analyses and interpretation. RESULTS Our sample included 14 parents, who were interviewed 1-2 times between November, 2019 and July, 2020. Most patients were mothers (71%), Latinx (64%), with household incomes <$30K (42%). Data analysis led to the development of a Grounded Theory called Developing a Sense of Self-Reliance with three categories: (1) Owning caregiving responsibilities despite grave fears, (2) Figuring out how "to make it work" in the interstage period, and (3) Gaining a sense of self-reliance. CONCLUSIONS Parents transitioned to caregiver roles by developing a sense of self-reliance and, in the process, gained self-confidence and decision-making skills. Our study responded to the key research priority from the AHA Scientific Statement to address the knowledge gap in home monitoring for interstage infants through qualitative research design.
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40
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Adedinsewo DA, Pollak AW, Phillips SD, Smith TL, Svatikova A, Hayes SN, Mulvagh SL, Norris C, Roger VL, Noseworthy PA, Yao X, Carter RE. Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools. Circ Res 2022; 130:673-690. [PMID: 35175849 PMCID: PMC8889564 DOI: 10.1161/circresaha.121.319876] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.
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Affiliation(s)
- Demilade A. Adedinsewo
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Amy W. Pollak
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Sabrina D. Phillips
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Taryn L. Smith
- Division of General Internal Medicine (T.L.S.), Mayo Clinic, Jacksonville, FL
| | - Anna Svatikova
- Department of Cardiovascular Diseases (A.S.), Mayo Clinic, Phoenix, AZ
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada (S.L.M.)
| | - Colleen Norris
- Cardiovascular Health and Stroke Strategic Clinical Network, Edmonton, Canada (C.N.)
| | - Veronique L. Roger
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences (V.L.R.), Mayo Clinic, Rochester, MN
- Epidemiology and Community Health Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.R.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences (R.E.C.), Mayo Clinic, Jacksonville, FL
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Foster C, Schinasi D, Kan K, Macy M, Wheeler D, Curfman A. Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics. Pediatrics 2022; 149:184460. [PMID: 35102417 PMCID: PMC9215346 DOI: 10.1542/peds.2021-054137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 01/25/2023] Open
Abstract
In this article, we provide an overview of remote monitoring of pediatric PGHD and family-generated health data, including its current uses, future opportunities, and implementation resources.
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Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care,
Department of Pediatrics, Feinberg School of Medicine, Northwestern University,
Chicago, Illinois,Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center,Digital Health Programs,Address correspondence to Carolyn Foster, MD, MSHS, Division of
Advanced General Pediatrics and Primary Care, Department of Pediatrics, Feinberg
School of Medicine, Northwestern University and Mary Ann & J. Milburn Smith
Child Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie
Children’s Hospital of Chicago, 225 E Chicago Ave, Box 162, Chicago, IL
60611. E-mail:
| | - Dana Schinasi
- Digital Health Programs,Divisions of Pediatric Emergency Medicine
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care,
Department of Pediatrics, Feinberg School of Medicine, Northwestern University,
Chicago, Illinois,Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center
| | - Michelle Macy
- Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center,Digital Health Programs,Divisions of Pediatric Emergency Medicine
| | - Derek Wheeler
- Critical Care and Hospital-Based Medicine, Ann &
Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:309-324. [PMID: 36479525 PMCID: PMC9510217 DOI: 10.1007/s40746-022-00258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
Purpose of Review Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice. Recent Findings In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence. Summary TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.
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43
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Adapting Interstage Home Monitoring with the use of Telemedicine During the COVID-19 Pandemic. Pediatr Cardiol 2022; 43:1136-1140. [PMID: 35192020 PMCID: PMC8861595 DOI: 10.1007/s00246-022-02835-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/24/2022] [Indexed: 11/05/2022]
Abstract
Pediatric single ventricle patients have seen dramatic improvements in overall outcomes over the past several decades. This is attributed to the development of home monitoring programs for interstage patients. In today's current COVID-19 pandemic, the use of telemedicine has allowed providers to care for these patients and support their families effectively while minimizing the risk of COVID-19 exposure. Our single-center study reviewed the charts of nine patients followed by our single ventricle team through the COVID-19 pandemic. Patients discharged from the hospital and enrolled in our digital home monitoring program were included. Records were retrospectively reviewed for total number of outpatient visits, adverse events, unplanned hospital readmissions, and unplanned procedures. These results were then compared to outcomes from 2018 to 2019. In-person visits averaged every 6 weeks compared to every 2-3-week pre-pandemic. Zero adverse events reported with the use of telemedicine compared to one adverse event pre-pandemic. There was a 50% decrease in unplanned readmissions and 60% decrease in unplanned procedures during our study period. One patient was diagnosed with acute COVID-19 infection and managed conservatively via telemedicine with full recovery. To our knowledge, this is the only case-control study reporting the use of telemedicine during the COVID-19 pandemic in the interstage population. Although not statistically significant, we report a decrease in total adverse events, unplanned procedures, and unplanned admissions. Telemedicine visits allowed for identification of issues requiring hospital readmission as well as conservative management of one patient with COVID-19.
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44
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Aly DM, Erickson LA, Hancock H, Apperson JW, Gaddis M, Shirali G, Goudar S. Ability of Video Telemetry to Predict Unplanned Hospital Admissions for Single Ventricle Infants. J Am Heart Assoc 2021; 10:e020851. [PMID: 34365801 PMCID: PMC8475020 DOI: 10.1161/jaha.121.020851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Our Cardiac High Acuity Monitoring Program (CHAMP) uses home video telemetry (HVT) as an adjunct to monitor infants with single ventricle during the interstage period. This study describes the development of an objective early warning score using HVT, for identification of infants with single ventricle at risk for clinical deterioration and unplanned hospital admissions (UHA). Methods and Results Six candidate scoring parameters were selected to develop a pragmatic score for routine evaluation of HVT during the interstage period. We evaluated the individual and combined ability of these parameters to predict UHA. All infants with single ventricle monitored at home by CHAMP between March 2014 and March 2018 were included. Videos obtained within 48 hours before UHA were compared with videos obtained at baseline. We used binary logistic regression models and receiver operating characteristic curves to evaluate the parameters' performance in discriminating the outcome of interest. Thirty‐nine subjects with 64 UHA were included. We compared 64 pre‐admission videos to 64 paired baseline videos. Scoring was feasible for a mean of 91.6% (83.6%–98%) of all observations. Three different HVT score models were proposed, and a final model composed of respiratory rate, respiratory effort, color, and behavior exhibited an excellent discriminatory capability with an area under the receiver operating characteristic curve of 93% (89%–98%). HVT score of 5 was associated with specificity of 93.8% and sensitivity of 88.7% in predicting UHA. Conclusions We developed a feasible and reproducible HVT score that can serve as a tool to predict UHA in infants with single ventricle. Future directions involve prospective, multicenter validation of this tool.
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Affiliation(s)
- Doaa M Aly
- Ward Family Heart Center Children's Mercy Hospital Kansas City MO
| | - Lori A Erickson
- Ward Family Heart Center Children's Mercy Hospital Kansas City MO
| | - Hayley Hancock
- Ward Family Heart Center Children's Mercy Hospital Kansas City MO
| | | | - Monica Gaddis
- Department of Biomedical and Health Informatics UMKC School of Medicine Kansas City MO
| | - Girish Shirali
- Ward Family Heart Center Children's Mercy Hospital Kansas City MO
| | - Suma Goudar
- Children's National Heart Institute Washington DC
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Andrews JS, Machovec KA. Home is Where the Heart Is: Interstage Home Monitoring in Infants With Single-Ventricle Heart Disease. J Cardiothorac Vasc Anesth 2021; 35:2835-2837. [PMID: 34172368 DOI: 10.1053/j.jvca.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022]
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Integrated Multimodality Telemedicine to Enhance In-Home Care of Infants During the Interstage Period. Pediatr Cardiol 2021; 42:349-360. [PMID: 33079264 PMCID: PMC7573871 DOI: 10.1007/s00246-020-02489-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/08/2020] [Indexed: 12/04/2022]
Abstract
Performing interstage home monitoring using digital platforms (teleIHM) is becoming commonplace but, when used alone, may still require frequent travel for in-person care. We evaluated the acceptability, feasibility, and added value of integrating teleIHM with synchronous telemedicine video visits (VVs) and asynchronous video/photo sharing (V/P) during the interstage period. We conducted a descriptive program evaluation of patient-families receiving integrated multimodality telemedicine (teleIHM + VV + V/P) interstage care from 7/15/2018 to 05/15/2020. First, provider focus groups were conducted to develop a program logic model. Second, patient characteristics and clinical course were reviewed and analyzed with univariate statistics. Third, semi-structured qualitative interviews of family caregivers' experiences were assessed using applied thematic analysis. Within the study period, 41 patients received teleIHM + VV + V/P care, of which 6 were still interstage and 4 died. About half (51%) of patients were female and 54% were a racial/ethnic minority. Median age was 42 days old (IQR 25, 58) at interstage start, with a median of 113 total days (IQR 72, 151). A total of 551 VVs were conducted with a median 12 VVs (IQR 7, 18) per patient. Parents sent a median 2 pictures (IQR 0-3, range 0-82). Qualitatively, families reported an adjustment period to teleIHM, but engaged favorably with telemedicine overall. Families felt reassured by the oversight routine telemedicine provided and identified logistical and clinical value to VVs above teleIHM alone, while acknowledging trade-offs with in-person care. Integration of multimodality telemedicine is a feasible and acceptable approach to enhance in-home care during the interstage period.
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Rudd NA, Ghanayem NS, Hill GD, Lambert LM, Mussatto KA, Nieves JA, Robinson S, Shirali G, Steltzer MM, Uzark K, Pike NA. Interstage Home Monitoring for Infants With Single Ventricle Heart Disease: Education and Management: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2020; 9:e014548. [PMID: 32777961 PMCID: PMC7660817 DOI: 10.1161/jaha.119.014548] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This scientific statement summarizes the current state of knowledge related to interstage home monitoring for infants with shunt-dependent single ventricle heart disease. Historically, the interstage period has been defined as the time of discharge from the initial palliative procedure to the time of second stage palliation. High mortality rates during the interstage period led to the implementation of in-home surveillance strategies to detect physiologic changes that may precede hemodynamic decompensation in interstage infants with single ventricle heart disease. Adoption of interstage home monitoring practices has been associated with significantly improved morbidity and mortality. This statement will review in-hospital readiness for discharge, caregiver support and education, healthcare teams and resources, surveillance strategies and practices, national quality improvement efforts, interstage outcomes, and future areas for research. The statement is directed toward pediatric cardiologists, primary care providers, subspecialists, advanced practice providers, nurses, and those caring for infants undergoing staged surgical palliation for single ventricle heart disease.
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