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Klais M, Doll U, Purbojo A, Dittrich S, Rottermann K. The Congenital Cardiology Cloud: Proof of feasibility of Germany's first tele-medical network for pediatric cardiology. J Telemed Telecare 2024; 30:1573-1580. [PMID: 36938629 DOI: 10.1177/1357633x231158838] [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: 03/21/2023]
Abstract
BACKGROUND For an optimal interplay based on the data-secure exchange of diagnostic data between patients, ambulatory care, and hospital care, we implemented the first tele-medical network for pediatric cardiology in Germany, the Congenital Cardiology Cloud. This study focuses on its feasibility, technical characteristics, and implementation in routine clinical work. METHODS Tele-medical traffic comprised numbers of incoming/outgoing data, related file types, treatment options for tele-medically processed patients, and patient classification with respect to the severity of disease. Proof of feasibility was related to the number of successful tele-medical transmissions of discharge documents at the end of the observation period (02/2020-10/2020). RESULTS Analysis of Congenital Cardiology Cloud's data communication showed a number of 1178 files for a total of 349 patients, favoring transmissions towards the clinic. Incoming traffic was predominantly characterized by diagnostic data regarding tele-consultations (76.6%), consisting of a multitude of file types, whereas 93.4% of the dispatched data corresponded to discharge letters. The number of tele-consultations counted up to 61, with a necessary subsequent treatment or diagnostic procedure in 90.2% of the presented cases. Tele-medically processed patients generally showed to be more complex (severe chronic heart disease 42.4% vs. 23.7%). At the end of the observation period, 97.6% of the discharge documents were transmitted via telemedicine. DISCUSSION The implementation of the first tele-medical network for pediatric cardiology in Germany proves recent technological developments to successfully enable innovative patient care, connecting the ambulatory and hospital sector for a joint patient advice, predominantly in more complex cases. Possible governmentally guided refinancing concepts will show its long-term feasibility.
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Affiliation(s)
- Marko Klais
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Ulrike Doll
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Kathrin Rottermann
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
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Pieringer F, Suleiman MN, Kaemmerer-Suleiman AS, Dewald O, Freiberger A, Huntgeburth M, Nagdyman N, Neidenbach R, von Scheidt F, Kaemmerer H, Ewert P, Weyand M, Freilinger S, Harig F. Continuous Long-Term Assessment of Heart Rate Variability in Adults with Cyanotic Congenital Heart Disease after Surgical Repair. J Clin Med 2024; 13:2062. [PMID: 38610825 PMCID: PMC11012901 DOI: 10.3390/jcm13072062] [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: 02/20/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Heart rate variability (HRV) is an established, non-invasive parameter for the assessment of cardiac autonomic nervous activity and the health status in general cardiology. However, there are few studies on HRV in adults with congenital heart defects (CHDs). The aim of the present study was to evaluate the use of long-term continuous HRV measurement for the assessment of global health status in adults with cyanotic CHD. Methods: This prospective study included 45 adults (40% female, mean age = 35.2 ± 9.2 [range: 19-58] years) after cardiac surgical repair. HRV parameters were calculated from continuous 24 h measurements using a Bittium Faros 180 sensor (Bittium Corp., Oulu, Finland). Results: Postoperative patients with transposition of the great arteries (TGA) (n = 18) achieved significantly higher values of standard deviation of NN intervals (SDNN) (175.4 ± 59.9 ms vs. 133.5 ± 40.6 ms; p = 0.013) compared with patients with other conotruncal anomalies (n = 22). Comparing patients with TGA after a Senning-Brom or Mustard operation (n = 13) with all other heart surgery patients (n = 32), significantly higher HRV parameters were found after atrial switch (root mean square of successive RR interval differences: 53.6 ± 20.7 ms vs. 38.4 ± 18.3 ms; p = 0.019; SDNN: 183.5 ± 58.4 ms vs. 136.3 ± 45.3 ms; p = 0.006). A higher SDNN was also measured after Senning-Brom or Mustard operations than after a Rastelli operations (n = 2) (SDNN: 183.5 ± 58.4 ms vs. 84.5 ± 5.2 ms; p = 0.037). When comparing atrial switch operations (n = 3) with Rastelli operations, the SDNN value was significantly shorter in the Rastelli group (p = 0.004). Conclusions: Our results suggest that continuous HRV monitoring may serve as a marker of cardiac autonomic dysfunction in adults with cyanotic CHD after surgical repair. Impaired cardiac autonomic nervous activity may be associated with an increased risk of adverse reactions in patients with repaired CHD. Therefore, a longitudinal assessment of HRV patterns and trends may provide a deeper insight into dynamic changes in their autonomic regulation and disease progression, lifestyle changes, or treatments. As each person has individual variability in heart rate, HRV may be useful in assessing intra-individual disease progression and may help to improve personalized medicine. Further studies are needed to better understand the underlying mechanisms and to explore the full potential of HRV analysis to optimize medical care for ACHDs.
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Affiliation(s)
- Felix Pieringer
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Mathieu N. Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Ann-Sophie Kaemmerer-Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Annika Freiberger
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Michael Huntgeburth
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Nicole Nagdyman
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Rhoia Neidenbach
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
- Department of Sport and Health Sciences, Technical University Munich, 80992 Munich, Germany
| | - Fabian von Scheidt
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Harald Kaemmerer
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Peter Ewert
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sebastian Freilinger
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
- Department of Sport and Health Sciences, Technical University Munich, 80992 Munich, Germany
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
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Freilinger S, Kaemmerer H, Pittrow RD, Achenbach S, Baldus S, Dewald O, Ewert P, Freiberger A, Gorenflo M, Harig F, Hohmann C, Holdenrieder S, Hörer J, Huntgeburth M, Hübler M, Kohls N, Klawonn F, Kozlik-Feldmann R, Kaulitz R, Loßnitzer D, Mellert F, Nagdyman N, Nordmeyer J, Pittrow BA, Pittrow LB, Rickers C, Rosenkranz S, Schelling J, Sinning C, Suleiman MN, von Kodolitsch Y, von Scheidt F, Kaemmerer-Suleiman AS. PATHFINDER-CHD: prospective registry on adults with congenital heart disease, abnormal ventricular function, and/or heart failure as a foundation for establishing rehabilitative, prehabilitative, preventive, and health-promoting measures: rationale, aims, design and methods. BMC Cardiovasc Disord 2024; 24:181. [PMID: 38532336 DOI: 10.1186/s12872-024-03833-y] [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: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Adults with congenital heart defects (ACHD) globally constitute a notably medically underserved patient population. Despite therapeutic advancements, these individuals often confront substantial physical and psychosocial residua or sequelae, requiring specialized, integrative cardiological care throughout their lifespan. Heart failure (HF) is a critical challenge in this population, markedly impacting morbidity and mortality. AIMS The primary aim of this study is to establish a comprehensive, prospective registry to enhance understanding and management of HF in ACHD. Named PATHFINDER-CHD, this registry aims to establish foundational data for treatment strategies as well as the development of rehabilitative, prehabilitative, preventive, and health-promoting interventions, ultimately aiming to mitigate the elevated morbidity and mortality rates associated with congenital heart defects (CHD). METHODS This multicenter survey will be conducted across various German university facilities with expertise in ACHD. Data collection will encompass real-world treatment scenarios and clinical trajectories in ACHD with manifest HF or at risk for its development, including those undergoing medical or interventional cardiac therapies, cardiac surgery, inclusive of pacemaker or ICD implantation, resynchronization therapy, assist devices, and those on solid organ transplantation. DESIGN The study adopts an observational, exploratory design, prospectively gathering data from participating centers, with a focus on patient management and outcomes. The study is non-confirmatory, aiming to accumulate a broad spectrum of data to inform future hypotheses and studies. PROCESSES Regular follow-ups will be conducted, systematically collecting data during routine clinical visits or hospital admissions, encompassing alterations in therapy or CHD-related complications, with visit schedules tailored to individual clinical needs. ASSESSMENTS Baseline assessments and regular follow-ups will entail comprehensive assessments of medical history, ongoing treatments, and outcomes, with a focus on HF symptoms, cardiac function, and overall health status. DISCUSSION OF THE DESIGN The design of the PATHFINDER-CHD Registry is tailored to capture a wide range of data, prioritizing real-world HF management in ACHD. Its prospective nature facilitates longitudinal data acquisition, pivotal for comprehending for disease progression and treatment impacts. CONCLUSION The PATHFINDER-CHD Registry is poised to offer valuable insights into HF management in ACHD, bridging current knowledge gaps, enhancing patient care, and shaping future research endeavors in this domain.
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Affiliation(s)
- Sebastian Freilinger
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Harald Kaemmerer
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Robert D Pittrow
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Achenbach
- Department of Cardiology, Medizinische Klinik 2 - Kardiologie und Angiologie University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Baldus
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Ewert
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Annika Freiberger
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Matthias Gorenflo
- Department of Paediatric Cardiology and Congenital Heart Disease Center for Child and Adolescent Health, Medical Center-University of Heidelberg, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christopher Hohmann
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technical University Munich, München, Germany
| | - Jürgen Hörer
- Department for Congenital and Paediatric Surgery, German Heart Center Munich, Technical University Munich, München, Germany
- Division for Congenital and Pediatric Heart Surgery, University Hospital of Munich (LMU), Munich, Germany
- European Pediatric Heart Center, Munich, Germany
| | - Michael Huntgeburth
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | | | - Niko Kohls
- Faculty of Applied Natural Sciences and Health, Division of Health Promotion, University of Applied Sciences and Arts Coburg, Coburg, Germany
| | - Frank Klawonn
- Helmholtz Centre for Infection Research, Biostatistics Research Group, Brunswick, Germany
| | | | - Renate Kaulitz
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Dirk Loßnitzer
- Department of Paediatric Cardiology and Congenital Heart Disease Center for Child and Adolescent Health, Medical Center-University of Heidelberg, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Friedrich Mellert
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicole Nagdyman
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Johannes Nordmeyer
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Benjamin A Pittrow
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Leonard B Pittrow
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Stefan Rosenkranz
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Mathieu N Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Fabian von Scheidt
- International Center for Adults With Congenital Heart Disease, Clinic for Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, München, Germany
| | - Ann-Sophie Kaemmerer-Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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Tyagi A, Sontakke T. The Transition of Children Living With Congenital Heart Disease to Adult Care. Cureus 2023; 15:e50179. [PMID: 38186454 PMCID: PMC10771806 DOI: 10.7759/cureus.50179] [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: 08/22/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
The article explores the significance of the timely transition of a child living with congenital heart disease (CHD) to adult care and the role played by multidisciplinary care. Due to recent healthcare advances, more children with CHD survive to adulthood without surgical intervention. This survival is mainly due to the lesion being compatible with life and its management being done medically. However, further management requires meeting the child's needs and helping him transition to become a healthy, independent adult with almost equal life expectancy as his counterparts. The article reviews the comprehensive framework of transition through multidisciplinary care. Highlighting the necessity of training physicians to acquire expertise in the management of CHD is a foundational aspect of this review article. Introduction to transition requires assessment of the child's needs through all phases of life and informative counseling of both parents and child. It highlights the approach to educating patients and families with the knowledge to safeguard compliance. Multidisciplinary collaboration from various fields such as cardiology, pediatric physiatrist, nursing, and psychology has been stressed. Patients also need to cultivate skills in self-management and independence and be educated to comprehend their condition, including the potential health issues. This collaborative and multidisciplinary process necessitates the cooperation of patients, families, and the adult congenital heart disease (ACHD) team. Emphasis has been given to individualized counseling for girls to address their sexual health. The article also highlights the possible obstacles and how to tackle them to improve healthcare adherence. Timely transition and follow-up can be measured using various tools or through indices measuring the quality of life and average life expectancy. The global patterns of transition to ACHD care have also been emphasized, as well as the need for research studies to develop reliable indicators for assessing transition success.
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Affiliation(s)
- Ashu Tyagi
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Sontakke
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Haeffele C, Sillman C. The Resilient Heart: Exploring Post-Traumatic Stress in Adult Patients With Congenital Heart Disease. Am J Cardiol 2023; 205:514-515. [PMID: 37612217 DOI: 10.1016/j.amjcard.2023.07.147] [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: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Christiane Haeffele
- Departments of Medicine; Pediatrics, Stanford University School of Medicine, Palo Alto, California..
| | - Christina Sillman
- Departments of Medicine; Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Effects of Sports, Exercise Training, and Physical Activity in Children with Congenital Heart Disease-A Review of the Published Evidence. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020296. [PMID: 36832425 PMCID: PMC9955038 DOI: 10.3390/children10020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Children and adolescents with congenital heart disease (CHD) should be encouraged to adopt a physically active lifestyle, ideally by participating in sports activities at school and sports clubs. Children with complex CHD or other risk factors (for example, pacemakers, cardioverter-defibrillators, channelopathies) may, however, need specific individualized training programs. This review article summarizes the current knowledge regarding the clinical effects of sports and exercise training on CHD and its pathophysiologic mechanisms. An evidence-based approach based on a literature search, using PubMed, Medline, CINHAL, Embase, and the Cochrane Library was conducted, last completed on 30 December 2021. In studies with 3256 CHD patients in total, including 10 randomized controlled trials, 14 prospective interventional trials, 9 observational trials, and 2 surveys, exercise training has been shown to improve exercise capacity and physical activity, motoric skills, muscular function, and quality of life. Sports and exercise training appears to be effective and safe in CHD patients. Despite being cost-efficient, training programs are currently scarcely reimbursed; therefore, support from healthcare institutions, commissioners of healthcare, and research-funding institutions is desirable. There is a strong need to establish specialized rehabilitation programs for complex CHD patients to enhance these patients' access to this treatment intervention. Further studies may be desirable to confirm these data to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.
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Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults. Nat Rev Cardiol 2023; 20:126-137. [PMID: 36045220 DOI: 10.1038/s41569-022-00749-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.
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Vollbrecht TM, Luetkens JA. [Cardiac MRI of congenital heart disease : From fetus to adult]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:933-940. [PMID: 35976404 DOI: 10.1007/s00117-022-01062-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is an important diagnostic tool for initial diagnostic workup and follow-up of patients with congenital heart disease (CHD) of different age groups. OBJECTIVES This review provides an overview of clinically applied MRI sequences for the assessment of CHD, highlights technical developments, and demonstrates key aspects of reporting in specific heart defects. MATERIALS AND METHODS Presentation of epidemiologic data, summary of studies on MRI sequences and their clinical application, and demonstration of clinical examples. RESULTS The broad spectrum of congenital heart defects requires the use of various sequences, which can be modified depending on patient age or treatment status. Cine imaging can be used to assess cardiac function and volumes, phase contrast flow measurements allow for the assessment of vessel hemodynamics, and various techniques of MR angiography allow visualization of the thoracic vessels with high spatiotemporal resolution. New developments allow high-resolution vascular imaging without the need for contrast agents, assessment of additional hemodynamic parameters, or fetal cardiac MRI. CONCLUSION Cardiac MRI can be employed in children as well as in adults with CHD. By using different sequences and considering the treatment status and surgery-related complications, the vast majority of clinical questions can be answered.
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Affiliation(s)
- Thomas M Vollbrecht
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Deutschland
| | - Julian A Luetkens
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Deutschland.
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Coats L, Chaudhry B. Ambulatory Care in Adult Congenital Heart Disease-Time for Change? J Clin Med 2022; 11:jcm11072058. [PMID: 35407666 PMCID: PMC9000074 DOI: 10.3390/jcm11072058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. METHODS A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020-July 2021). RESULTS Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6-265), resulting in 433-564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. CONCLUSION The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.
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Affiliation(s)
- Louise Coats
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Correspondence:
| | - Bill Chaudhry
- Bioscience Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
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[Care of adults with congenital heart diseases in Germany-Leading role by internal medicine specialists and general practitioners]. Internist (Berl) 2022; 63:95-102. [PMID: 34985563 DOI: 10.1007/s00108-021-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The number of adults with congenital heart disease (ACHD) is steadily increasing. The present cross-sectional study was conceived to investigate ACHD care from the perspective of patients and family practitioners (specialists for general medicine and internal medicine, general practitioners). METHODS Questionnaire-based cross-sectional study to analyze the real care situation of ACHD in Germany from the perspective of patients and primary care physicians (PCP). RESULTS The questionnaire was completed by 4493 ACHD (53.7% female; 41.3 ± 16.9 years) and 1055 PCP. The majority of ACHD (79.8%) visited their PCP for noncardiac health problems but also for cardiac problems. Almost all ACHD had substantial needs for medical consultation (performance, employment etc.). Of the patients 2014 (44.8%) did not know of any certified ACHD specialists or specialized centers and 2816 (62.7%) respondents were not aware of any ACHD patient organization. Of the PCPs 87.5% had cared for ACHD of all severities due to defect-typical residual and resulting symptoms. Many were not aware of any certified ACHD specialists. Only 28.5% consulted an ACHD specialist. Only 23.5% were aware of ACHD patient organizations. CONCLUSION General practitioners are a mainstay of ACHD care in Germany. The present study shows that ACHD and their general practitioners are largely uninformed about the specialized care structures available nationwide, despite the high level of need for specialist care. In order to keep the morbidity and mortality of affected patients low, solutions must be elaborated in future to involve and integrate primary care physicians more intensively into the already existing dedicated ACHD care structures, in cooperation with specialized pediatric cardiologists, cardiologists and centers.
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Kaemmerer AS, Gorenflo M, Huscher D, Pittrow D, Ewert P, Pausch C, Delcroix M, Ghofrani HA, Hoeper MM, Kozlik-Feldmann R, Skride A, Stähler G, Vizza CD, Jureviciene E, Jancauskaite D, Gumbiene L, Ewert R, Dähnert I, Held M, Halank M, Skowasch D, Klose H, Wilkens H, Milger K, Jux C, Koestenberger M, Scelsi L, Brunnemer E, Hofbeck M, Ulrich S, Vonk Noordegraaf A, Lange TJ, Bruch L, Konstantinides S, Claussen M, Löffler-Ragg J, Wirtz H, Apitz C, Neidenbach R, Freilinger S, Nemes A, Opitz C, Grünig E, Rosenkranz S. Medical treatment of pulmonary hypertension in adults with congenital heart disease: updated and extended results from the International COMPERA-CHD Registry. Cardiovasc Diagn Ther 2021; 11:1255-1268. [PMID: 35070795 PMCID: PMC8748472 DOI: 10.21037/cdt-21-351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data. METHODS The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD. RESULTS A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described. CONCLUSIONS Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients. TRIAL REGISTRATION www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Matthias Gorenflo
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Angelika-Lautenschläger-Klinik, Heidelberg, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin, Berlin, Germany
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University, Dresden, Germany
| | - Peter Ewert
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | | | - Marion Delcroix
- UZ Leuven, Campus Gasthuisberg, Department of Pneumology, Leuven, Belgium
| | - Hossein A. Ghofrani
- Universitätsklinikum Gießen und Marburg GmbH, Medizinische Klinik II/V, Gießen, Germany
| | - Marius M. Hoeper
- Medizinische Hochschule Hannover, Abt. Pneumologie, Hannover, Germany
| | - Rainer Kozlik-Feldmann
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Germany
| | - Andris Skride
- Riga Stradins University, Clinical University Hospital, Riga, Lativa
| | - Gerd Stähler
- Klinik Löwenstein, Medizinische Klinik I, Löwenstein, Germany
| | - Carmine Dario Vizza
- Pulmonary Hypertension Center, Department of Clinical Anestesiologic and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Elena Jureviciene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dovile Jancauskaite
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Gumbiene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Greifswald, Germany
| | - Ingo Dähnert
- Herzzentrum Leipzig GmbH, Klinik für Kinderkardiologie, Leipzig, Germany
| | - Matthias Held
- Med. Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg, Germany
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin - Kardiologie/Pneumologie, Bonn
| | - Hans Klose
- Abteilung für Pneumologie, Zentrum für Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Heinrike Wilkens
- Universitätsklinikum des Saarlandes, Innere Medizin V, Homburg, Germany
| | - Katrin Milger
- LMU Klinikum, Medizinische Klinik und Poliklinik V, München, Germany
| | - Christian Jux
- Kinderherzzentrum und Zentrum für angeborene Herzfehler, Justus-Liebig-Universität, Zentrum für Kinderheilkunde, Abteilung Kinderkardiologie, Gießen, Germany
| | - Martin Koestenberger
- LKH - Univ. Klinikum Graz, Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Kardiologie, Graz, Austria
| | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo University of Pavia, Pavia, Italy
| | - Eva Brunnemer
- Medizinische Universitätsklinik (Krehl-Klinik), Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), Heidelberg, Germany
| | - Michael Hofbeck
- Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Kinderkardiologie, Pulmologie, Intensivmedizin, Tübingen, Germany
| | - Silvia Ulrich
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich, Switzerland
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, dept of Pulmonary Medicine, Amsterdam, Netherlands
| | - Tobias J. Lange
- Universitätsklinikum Regensburg, Medizinische Klinik und Poliklinik II, Regensburg, Germany
| | - Leonhard Bruch
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin, Berlin, Germany
| | | | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, Großhansdorf, Germany
| | | | - Hubert Wirtz
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik I, Abteilung für Pneumologie, Leipzig, Germany
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Kardiologie, Ulm, Germany
| | - Rhoia Neidenbach
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Sebastian Freilinger
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Attila Nemes
- University of Szeged, Department of Medicine, Szeged, Hungary
| | - Christian Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, Berlin, Germany
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg gGmbH, Zentrum für Pulmonale Hypertonie, Heidelberg, and German Centre for Lung Research, Heidelberg, Germany
| | - Stephan Rosenkranz
- Universitätsklinik Köln – Herzzentrum, Klinik III für Innere Medizin, Köln, Germany
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Huntgeburth M, Hohmann C, von Scheidt F, Meierhofer C. Überraschende Echobefunde als Erstdiagnose eines angeborenen Herzfehlers im Erwachsenenalter. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1535-3115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungAngeborene Herzfehler (AHF) werden teilweise erst im Erwachsenenalter diagnostiziert, entweder weil sie erst dann klinisch auffällig werden oder bei vorausgegangenen Untersuchungen übersehen wurden. Im Rahmen einer routinemäßigen transthorakalen Echokardiografie (TTE) können in der kardiologischen Praxis oder Klinik angeborene kardiale Anomalien leicht fehlgedeutet werden, da der Fokus in der Erwachsenenkardiologie überwiegend bei erworbenen Herzfehlern, einer Kardiomyopathie, Klappenerkrankungen oder einer systolischen oder diastolischen Dysfunktion liegt. Demgegenüber spielt eine thematische Auseinandersetzung mit AHF häufig eine nur untergeordnete Rolle, die Erwartungshaltung hinsichtlich angeborener kardialer Anomalien ist eher gering und die Sinne für mögliche AHF oft nicht geschärft. Dieser Artikel soll dazu beitragen, die Wahrscheinlichkeit des Erkennens eines AHF im Rahmen der TTE-Untersuchung zu erhöhen.
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Affiliation(s)
- Michael Huntgeburth
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Technische Universität München, Deutschland
| | - Christopher Hohmann
- Klinik III für Innere Medizin, Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Universitätsklinikum Köln, Köln, Deutschland
| | - Fabian von Scheidt
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Technische Universität München, Deutschland
| | - Christian Meierhofer
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Technische Universität München, Deutschland
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Andonian CS, Freilinger S, Achenbach S, Ewert P, Gundlach U, Hoerer J, Kaemmerer H, Pieper L, Weyand M, Neidenbach RC, Beckmann J. 'Well-being paradox' revisited: a cross-sectional study of quality of life in over 4000 adults with congenital heart disease. BMJ Open 2021; 11:e049531. [PMID: 34158308 PMCID: PMC8220527 DOI: 10.1136/bmjopen-2021-049531] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The present cross-sectional study investigated quality of life (QOL) in a large cohort of German adults with congenital heart disease (ACHDs) in association with patient-related and clinical variables. DESIGN Cross-sectional survey. PARTICIPANTS Between 2016 and 2019, a representative sample of 4014 adults with various forms of congenital heart defect (CHD) was retrospectively analysed. Inclusion criteria were confirmed diagnosis of CHD; participant aged 18 years and older; and necessary physical, cognitive and language capabilities to complete self-report questionnaires. PRIMARY AND SECONDARY OUTCOME MEASURES QOL was assessed using the 5-level EQ-5D version (EQ-5D-5L). Sociodemographic and medical information was obtained by a self-devised questionnaire. Associations of QOL with patient-reported clinical and sociodemographic variables were quantified using multiple regression analysis and multiple ordinal logit models. RESULTS Overall, ACHDs (41.8±17.2 years, 46.5% female) reported a good QOL comparable to German population norms. The most frequently reported complaints occurred in the dimensions pain/discomfort (mean: 16.3, SD: p<0.001) and anxiety/depression (mean: 14.3, p<0.001). QOL differed significantly within ACHD subgroups, with patients affected by pretricuspid shunt lesions indicating the most significant impairments (p<0.001). Older age, female sex, medication intake and the presence of comorbidities were associated with significant reductions in QOL (p<0.001). CHD severity was positively associated with QOL within the dimensions of self-care (OR 0.148, 95% CI 0.04 to 0.58) and mobility (OR 0.384, 95% CI 0.19 to 0.76). CONCLUSION Current findings temper widely held assumptions among clinicians and confirm that ACHDs experience a generally good QOL. However, specific subgroups may require additional support to cope with disease-related challenges. The negative correlation of QOL with age is especially alarming as the population of ACHDs is expected to grow older in the future. TRIAL REGISTRATION NUMBER DRKS00017699; Results.
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Affiliation(s)
- Caroline Sophie Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University Munich, Munich, Germany
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Ulrike Gundlach
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - Jürgen Hoerer
- Department for Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technical University of Dresden, Dresden, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Rhoia Clara Neidenbach
- Sports Medicine, Exercise Physiology and Prevention, Department of Sport Science, University of Vienna, Vienna, Austria
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University Munich, Munich, Germany
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Brisbane, Australia
- Health Research Institute, University of Limerick, Limerick, Ireland
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