Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease

BACKGROUND

Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.

OBJECTIVES

The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.

METHODS

Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.

RESULTS

In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.

CONCLUSIONS

Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.

A randomized controlled trial to assess the impact of psychoeducation on the quality of life of parents with children with congenital heart defects-Quantitative component

PURPOSE

To develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns.

METHODS

Participants were parents of inpatient newborns with the diagnosis of non-syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

RESULTS

Parents of eight newborns were allocated to the intervention group (n = 15 parents) and eight to the control group (n = 13 parents). It was performed as an intention-to-treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL-Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups.

CONCLUSIONS

The PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.

Improving the quality of life of parents of patients with congenital abnormalities using psychoeducational interventions: a systematic review

PURPOSE

To identify psychoeducational interventions that target parents of children with congenital abnormalities (CA) and evaluate their impact on quality of life (QoL).

METHODS

The search was conducted in six electronic databases, complemented by references of the studies found, studies of evidence synthesis, a manual search of relevant scientific meetings' abstracts and contact with experts. We included primary studies on parents of children with CA that studied psychoeducational interventions versus standard care. We assessed the risk of bias using Cochrane Collaboration's tool.

RESULTS

We included six studies focusing on congenital heart defects (CHD). They described four different psychoeducational strategies. In four studies, statistically significant differences were found. For clinical practice, we considered three interventions as more feasible: the Educational program for mothers, with a group format of four sessions weekly; CHIP-Family intervention, which includes a parental group workshop followed by an individual follow-up booster session; and WeChat educational health program with an online format.

CONCLUSIONS

This review is the first that assesses the impact of psychoeducational interventions targeted at parents of children with CA on their QoL. The best approach to intervention is multiple group sessions. Two essential strategies were to give support material, enabling parents to review, and the possibility of an online program application, increasing accessibility. However, because all included studies focus on CHD, generalizations should be made carefully. These findings are crucial to guide future research to promote and improve comprehensive and structured support for families and integrate them into daily practice.

Rationale, design and methodology of APPROACH-IS II: International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease

BACKGROUND

In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal. The APPROACH-IS II study was established to address these knowledge gaps. This paper presents the design and methodology of APPROACH-IS II.

METHODS/DESIGN

APPROACH-IS II is a cross-sectional global multicentric study that includes Part 1 (assessing PROs) and Part 2 (investigating the frailty phenotype of older adults). With 53 participating centers, located in 32 countries across six continents, the aim is to enroll 8000 patients with CHD. In Part 1, self-report surveys are used to collect data on PROs (e.g., quality of life, perceived health, depressive symptoms, autonomy support), and explanatory variables (e.g., social support, stigma, illness identity, empowerment). In Part 2, the cognitive functioning and frailty phenotype of older adults are measured using validated assessments.

DISCUSSION

APPROACH-IS II will generate a rich dataset representing the international experience of individuals in adult CHD care. The results of this project will provide a global view of PROs and the frailty phenotype of adults with CHD and will thereby address important knowledge gaps. Undoubtedly, the project will contribute to the overarching aim of improving optimal living and care provision for adults with CHD.

Impact in the quality of life of parents of children with chronic diseases using psychoeducational interventions - A systematic review with meta-analysis

OBJECTIVE

This study aimed to identify psychoeducational interventions applied to parents of children with chronic diseases and evaluate their impact on their quality of life (QoL).

METHODS

It was conducted in six databases, complemented by references from the included studies and other reviews, manual search, and contact with experts. We included primary studies on parents of children with chronic diseases that studied psychoeducational interventions versus standard care.

RESULTS

We screened 6604 titles and abstracts, reviewed the full text of 60 records, and included 37 primary studies. Half of the studies were on Asthma. We found three intervention formats: one-to-one (43%), groups (49%), and combined approach with individual and group settings (8%). More than 60% of the included studies found statistically significant differences between the intervention and the control group (p < 0.05).

CONCLUSION

Several interventions have shown efficacy in improving parental QoL. Despite that, there is insufficient evidence of interventions' implementation.

PRACTICE IMPLICATIONS

A holistic approach encompassing the patient and the family's biopsychosocial dimensions is fundamental in successfully managing chronic disease in children. It is vital to design and implement interventions accommodating the common issues experienced by children, parents, and families that deal with chronic childhood conditions. Systematic review registration number PROSPERO 2018 CRD42018092135.

Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers

BACKGROUND

Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event.

METHOD

Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women at risk were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses.

CONCLUSION

Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.

Correlates of postnatal depression in mothers and fathers

BACKGROUND

We compare and contrast some correlates of paternal and maternal depression after the live birth of a first child, as part of a longitudinal study.

METHOD

Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at six months antenatally and at 12 months postnatally and sub-samples were interviewed at three months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS) and a series of other questionnaires and interviews to measure different psychosocial variables. Profiles of risk factors associated with depression in the first postnatal year were analysed by means of logistic regressions.

RESULTS

In the mothers, aside from a history of depression, the only other powerful predictor of postnatal depression was the mean objective negative impact score of life events. 'Postnatal' depression in fathers was associated with a history of depression in themselves and with the presence of depression in their wives or partners during pregnancy and soon after delivery.

CONCLUSION

Prevention and early treatment of depression in fathers may benefit not only themselves but also their spouses and their children.