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von Scheidt F, Barth J, Ewert P, Freiberger A, Kaemmerer H. [Transition in patients with congenital heart disease]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2025:10.1007/s00108-025-01923-3. [PMID: 40387869 DOI: 10.1007/s00108-025-01923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Congenital heart defects are the most common singular congenital organ malformation. Due to advances in medical care, more than 95% of affected persons now reach adulthood. However, congenital heart defects are often associated with residuals or sequelae that require lifelong specialized care. Lack of or irregular follow-up care leads to worse outcomes. Nevertheless, follow-up care for adults with congenital heart disease (ACHD) is still often inconsistent in reality, and many patients receive care outside of qualified structures.The transition process-the shift from pediatric to adult medical care-is critical. Many affected individuals experience little to no subjective limitations at this stage. Nevertheless, they must gradually take responsibility for their health while adapting to an unfamiliar healthcare provider.A structured transition process aims to improve continuity of care, promote disease acceptance, and prevent gaps in medical care. Both, patients and their primary care providers must be well-informed and aware of specialized care structures. Interdisciplinary collaboration among primary care providers, pediatric and ACHD specialists, and adult cardiologists is essential and should be supported by transition programs or patient organizations.Failure in the transition process primarily puts at risk the health of affected individuals but can also unnecessarily strain the healthcare system. A successful transition and a comprehensive, specialized care network are key to sustainably improving the prognosis of ACHD patients.
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Affiliation(s)
- Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern, Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstr. 36, 80636, München, Deutschland.
- Kinderkardiologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Augsburg, Augsburg, Deutschland.
| | - Juliane Barth
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern, Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstr. 36, 80636, München, Deutschland
| | - Peter Ewert
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern, Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstr. 36, 80636, München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern, Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstr. 36, 80636, München, Deutschland
| | - Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern, Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstr. 36, 80636, München, Deutschland
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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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Freilinger S, Andric D, Andonian C, Beckmann J, Bongarth C, Einwang HP, Ewert P, Hofbeck M, Kaemmerer AS, Nagdyman N, Oberhoffer R, von Kodolitsch Y, Kaemmerer H, Neidenbach R. Lessons from the short- and mid-term outcome of medical rehabilitation in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:1416-1431. [PMID: 35070810 PMCID: PMC8748468 DOI: 10.21037/cdt-20-727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 02/10/2025]
Abstract
BACKGROUND The number of adults with congenital heart disease (ACHD) is steadily increasing. Over their life-time, many of the affected patients require medical rehabilitation after interventional or surgical treatment of residua, sequels or complications of their congenital heart defect (CHD). However, up to now only scarce data exist about indication, performance and outcomes of cardiac rehabilitation in ACHD. METHODS The course and outcome of rehabilitation after previous interventional or surgical treatment in ACHD was analyzed in a retrospective cohort study. RESULTS Two hundred and five ACHD {54% female; mean age 34±12 [16-68] years} with mild (23.9%), moderate (35.1%) or severe CHD (41.0%), of whom 32% had complex CHD, 21% right-ventricular outflow tract obstructions, 20% pre-tricuspid shunts, 18% left heart or aortic anomalies, 9% post-tricuspid shunts and 2% other congenital cardiac anomalies were included into analysis. The main indications for rehabilitation were a preceding surgical (92%) or interventional (3%) treatment of the underlying CHD immediately before rehabilitation. During rehabilitation, no severe complications occurred. The number of patients in function class I/II increased from 189 to 200 and decreased in class III/IV from 16 to 5. Cardiac medication could be reduced or stopped after rehabilitation in 194 patients, with the exception of ACE-inhibitors. There was an improvement in cardiovascular risk factors. While before medical treatment 77% (n=157) patients were capable of working, the number increased to 82% [168] at the end of rehabilitation. Throughout a follow-up 9.3% (n=19) of patients needed further cardiac interventions. CONCLUSIONS The current study provided for the first time comprehensive data on the course of rehabilitation in a large cohort of ACHD after surgical or interventional treatment. The overall outcome of ACHD after rehabilitation was uneventful and favorable. Further research is required to assess the clinical long-term outcome, the impact of rehabilitation on the quality of life, disease coping and employment. The results of this study can serve as a benchmark for the development of specific rehabilitation programs in ACHD.
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Affiliation(s)
- Sebastian Freilinger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Dario Andric
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Andonian
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
- Chair of Sportpsychology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Jürgen Beckmann
- Chair of Sportpsychology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
- Health Research Institute, University of Limerick, Ireland
| | | | | | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | | | - Ann-Sophie Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Rhoia Neidenbach
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
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Diller GP, Baumgartner H. Adäquate Versorgungsstrukturen und Bedeutung von Big-Data-Analysen bei EMAH-Patienten. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1556-0210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ZusammenfassungDa immer mehr Kinder mit angeborenem Herzfehler (AHF) überleben und ins Erwachsenenalter
eintreten, sind nunmehr rund zwei Drittel der aktuellen AHF-Patienten Erwachsene mit
angeborenen Herzfehlern (EMAH). Es wird geschätzt, dass in Deutschland aktuell ca. 350000
EMAH-Patienten leben, wobei die Zahl weiter rasch zunimmt. Die lebenslange kardiologische
Anbindung von EMAH-Patienten ist nach aktuellen Leitlinienempfehlungen erforderlich und mit
einer niedrigeren Letalität und Morbidität assoziiert. Somit ist die ausschließliche
hausärztliche Versorgung von EMAH-Patienten nicht ausreichend. EMAH-Patienten sind an
spezialisierte EMAH-Zentren/bei EMAH-Kardiologen anzubinden und sollten gemeinschaftlich mit
niedergelassenen kardiologischen Kollegen behandelt werden. Big Data und Methoden des
maschinellen Lernens sind integraler Bestandteil der Forschungsbemühungen bei EMAH-Patienten,
die unter einer chronischen, lebenslangen Erkrankung leiden. Methoden der künstlichen
Intelligenz werden die Versorgung von EMAH-Patienten in Zukunft effizienter machen und die
Reproduzierbarkeit von Bildgebungsuntersuchungen erhöhen.
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Affiliation(s)
- Gerhard-Paul Diller
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Munster, Deutschland
| | - Helmut Baumgartner
- Westfälische Wilhelms Universität Münster EMAH-Zentrum, Kardiologie Zentrum für Erwachsene mit angeborenen und erworbenen Herzfehlern, Universitätsklinikum Münster, Münster, Deutschland
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK). DER KARDIOLOGE 2021. [PMCID: PMC8319902 DOI: 10.1007/s12181-021-00493-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dieses Manual zur diagnostischen Herzkatheteruntersuchung (Teil 1) ist eine Anwendungsempfehlung für interventionell tätige Ärzte, die den gegenwärtigen Kenntnisstand unter Berücksichtigung neuester Studienergebnisse wiedergibt. Hierzu wurde in den einzelnen Kapiteln speziell auf die Alltagstauglichkeit der Empfehlungen geachtet, sodass dieses Manual jedem interventionell tätigen Kardiologen als Entscheidungshilfe im Herzkatheterlabor dienen soll. Trotz der von vielen Experten eingebrachten praktischen Hinweise kann dieses Manual dennoch nicht die ärztliche Evaluation des individuellen Patienten ersetzen und damit eine Anpassung der Diagnostik bzw. Therapie ersetzen.
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Affiliation(s)
- Holger M. Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Stephan Achenbach
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | | | - Alexander Bufe
- Medizinische Klinik I, Helios Klinikum Krefeld, Krefeld, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - Oliver Dörr
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Albrecht Elsässer
- Herz- Kreislauf-Zentrum, Universitätsklinik für Innere Medizin – Kardiologie, Klinikum Oldenburg, Oldenburg, Deutschland
| | - Luise Gaede
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | - Tommaso Gori
- Zentrum für Kardiologie – Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
| | - Hans M. Hoffmeister
- Klinik für Kardiologie und allgemeine Innere Medizin, Städtisches Klinikum Solingen gemeinnützige GmbH, Solingen, Deutschland
| | - Felix J. Hofmann
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Hugo A. Katus
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Pneumologie), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christoph Liebetrau
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
- Abteilung für Kardiologie, Campus der JLU, Kerkhoff Bad Nauheim, Bad Nauheim, Deutschland
- CCB – Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Deutschland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, München, Deutschland
| | - Matthias Pauschinger
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | - Thomas Schmitz
- Klinik für Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum, Essen, Deutschland
| | - Tim Süselbeck
- Kardiologische Praxisklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Wolfram Voelker
- Medizinische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jens Wiebe
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gemeinnützige GmbH, Ludwigshafen, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Christian Hamm
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Angiologie und Nephrologie, Universitätsklinik Frankfurt, Frankfurt, Deutschland
| | - Helge Möllmann
- Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Deutschland
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Freilinger S, Andonian C, Beckmann J, Ewert P, Kaemmerer H, Lang N, Nagdyman N, Oberhoffer-Fritz R, Pieper L, Schelling J, von Scheidt F, Neidenbach R. Differences in the experiences and perceptions of men and women with congenital heart defects: A call for gender-sensitive, specialized, and integrative care. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fischer AJ, Enders D, Wasmer K, Marschall U, Baumgartner H, Diller GP. Impact of specialized electrophysiological care on the outcome of catheter ablation for supraventricular tachycardias in adults with congenital heart disease: Independent risk factors and gender aspects. Heart Rhythm 2021; 18:1852-1859. [PMID: 34271174 DOI: 10.1016/j.hrthm.2021.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/24/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Limited data exist on the impact of gender and specialized care on the requirement of repeat treatment of supraventricular tachycardia (SVT) in adult patients with congenital heart disease (ACHDs). OBJECTIVE The study aimed to assess independent predictors of a combined end point of re-catheter ablation (CA) or cardioversion at 3 years of follow-up, including the impact of gender and specialized ACHD care. METHODS All ACHDs registered in a database of one of the largest German health insurers (≈9.2 million members) who underwent CA for SVT were analyzed. RESULTS Of 38,892 ACHDs 16 years or older, 485 (49.5% women; median age 58.4 years; interquartile range 42.1-70.8 years) underwent CA for SVT. Over 3-year follow-up, the number of yearly CA procedures increased significantly, particularly for atrial fibrillation (+195%) and atrial flutter (+108%). Moderate to severe complexity heart disease (odds ratio [OR] 1.66; P = .01), advanced age (OR 1.85 per year; P = .02), chronic kidney disease (OR 1.70; P = .01), and atrial fibrillation (OR 2.02; P = .002) emerged as independent predictors of retreatment. Retreatment was significantly less often performed if primary CA was carried out at a specialized CHD center (P = .009) in patients with moderate to severe complexity heart disease. Women treated in specialist centers had a 1.6-fold reduced risk of undergoing retreatment (P = .01). CONCLUSION CA for SVT is increasingly performed in ACHDs, especially for atrial flutter and atrial fibrillation. Patients with moderate and severe complexity congenital heart defects and female ACHDs benefit from upfront referral to specialized CHD centers for CA. Centralization of care for ACHD arrhythmias should thus be advocated.
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Affiliation(s)
- Alicia Jeanette Fischer
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany.
| | - Dominic Enders
- Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, Wuppertal, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany
| | - Gerhard-Paul Diller
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany
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Neidenbach R, Achenbach S, Andonian C, Bauer UMM, Ewert P, Freilinger S, Gundlach U, Kaemmerer AS, Nagdyman N, Nebel K, Oberhoffer R, Pieper L, Reinhard W, Sanftenberg L, von Scheidt F, Schelling J, Seidel L, Weyand M, Kaemmerer H. Systematic assessment of health care perception in adults with congenital heart disease in Germany. Cardiovasc Diagn Ther 2021; 11:481-491. [PMID: 33968627 PMCID: PMC8102265 DOI: 10.21037/cdt-20-825] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The number of adults with congenital heart disease (ACHD) is steadily rising due to increased survival rate and improved medical resources. Accordingly, more than 330,000 ACHD are currently living in Germany. Almost all of them require lifelong specialized medical follow-up for their chronic heart disease, often accompanied by residua, sequelae, or comorbidities. Primary care physicians (PCPs) are a crucial factor in directing patients to ACHD specialists or specialized institutions, but despite all efforts, the number of ACHD under specialized care is low, the lost-to-follow-up rate is high, and the morbidity and mortality is substantial. The present cross-sectional study was designed to systematically characterize the health care of ACHD from a patient perspective, including (I) use of medical care by ACHD, (II) medical counselling needs, and (III) perceived satisfaction with health care. METHODS The German-wide analysis was based on a 25-item questionnaire designed to address different aspects of medical status and health issues of ACHD from their own perspective, performed between May of 2017 and July of 2020. RESULTS A total of 4,008 ACHD (52% female; mean age 41.9±17.2 years) completed the questionnaire. The majority of ACHD (3,524, 87.9%) reported, that they consulted their PCP for non-cardiac health problems, and 49.7% (n=1,991) consulted their PCP also for medical problems associated with the underlying CHD. Almost all ACHD reported a need for medical advice concerning exercise capacity and daily life activities, occupational skills, pregnancy, rehabilitation, genetic counselling, insurance, and retirement. A total of 1,840 (45.9%) patients were not aware of the existence of certified ACHD specialists or centers. Moreover, 2,552 (67.6%) of those surveyed were uninformed about patient organizations for ACHD. CONCLUSIONS The present study demonstrates that ACHD are largely uninformed about the ACHD care structures available nationwide, although the patients have a great need for specialized follow-up, advice, and care.
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Affiliation(s)
- Rhoia Neidenbach
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
- Department of Sports Medicine, Exercise Physiology and Prevention, Institute of Sport Science, University of Vienna, Austria
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Caroline Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Ulrike M. M. Bauer
- Competence Network for Congenital Heart Defects, National Register for Congenital Heart Defects, Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Ulrike Gundlach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Ann-Sophie Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Renate Oberhoffer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
- Department of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technical University of Dresden, Germany
| | - Wibke Reinhard
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice, Ludwig-Maximilians-University Munich, Germany
| | - Fabian von Scheidt
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | | | - Lavinia Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
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De Torres-Alba F. Adult congenital heart disease in Spain: present situation and future perspectives. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:792-794. [PMID: 32600992 DOI: 10.1016/j.rec.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Fernando De Torres-Alba
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Münster, Germany.
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Cardiopatías congénitas del adulto en España: situación actual y perspectivas futuras. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Seidel L, Nebel K, Achenbach S, Bauer U, Ewert P, Freilinger S, Gundlach U, Kaemmerer H, Nagdyman N, Oberhoffer R, Pieper L, Reinhard W, Sanftenberg L, Schelling J, Weyand M, Neidenbach R. Facts about the General Medical Care of Adults with Congenital Heart Defects: Experience of a Tertiary Care Center. J Clin Med 2020; 9:E1943. [PMID: 32580342 PMCID: PMC7355698 DOI: 10.3390/jcm9061943] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Due to the increase in survival rates for congenital heart disease (CHD) in the last decades, over 90% of patients today reach adulthood. Currently, there are more than 300,000 adults with CHD (ACHD) living in Germany. They have an increased need for specialized medical care, since almost all ACHD have chronic heart disease and suffer from specific chronic symptoms, risks, and sequelae. Primary care physicians (PCPs) play a crucial role in referring patients to ACHD specialists or specialized institutions. This cross-sectional study is intended to clarify the real-world care of ACHD from the PCP's perspective. Methods: This analysis, initiated by the German Heart Centre Munich, was based on a 27-item questionnaire on actual ACHD health care practice in Germany from the PCP's perspective. Results: In total, 767 questionnaires were considered valid for inclusion. The majority of the PCPs were general practitioners (95.9%), and 84.1% had cared for ACHD during the past year. A majority (69.2%) of the PCPs had cared for patients with simple CHD, while 50.6% and 33.4% had cared for patients with moderate and severe CHD, respectively, in all age groups. PCPs treated almost all typical residual symptoms and sequelae, and advised patients regarding difficult questions, including exercise capacity, pregnancy, genetics, and insurance matters. However, 33.8% of the PCPs did not even know about the existence of certified ACHD specialists or centers. Only 23.9% involved an ACHD-specialized physician in their treatment. In cases of severe cardiac issues, 70.8% of the PCPs referred patients to ACHD-certified centers. Although 52.5% of the PCPs were not sufficiently informed about existing structures, 64.2% rated the current care situation as either "very good" or "good". Only 26.3% (n = 190) of the responding physicians were aware of patient organizations for ACHD. Conclusions: The present study showed that the majority of PCPs are not informed about the ACHD care structures available in Germany. The need for specialized ACHD follow-up care is largely underestimated, with an urgent need for optimization to reduce morbidity and mortality. For the future, solutions must be developed to integrate PCPs more intensively into the ACHD care network.
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Affiliation(s)
- Lavinia Seidel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany; (S.A.); (U.G.)
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, 13353 Berlin, Germany;
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Ulrike Gundlach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany; (S.A.); (U.G.)
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Renate Oberhoffer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
- Department of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
| | - Lars Pieper
- Department of Behavioural Epidemiology, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Wibke Reinhard
- Cardiology Department, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany;
| | - Linda Sanftenberg
- Institute of General Practice, University of the Ludwig-Maximilians-University Munich, 80336 Munich, Germany;
| | - Jörg Schelling
- Private Group Practice Martinsried, 82152 Martinsried, Germany;
| | - Michael Weyand
- Department of Cardiac Surgery, University of Erlangen, 91054 Erlangen, Germany;
| | - Rhoia Neidenbach
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018 : Position paper of the German Cardiac Society. Clin Res Cardiol 2019; 108:1175-1196. [PMID: 31076853 DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, health care providers and payer organizations. Due to the rapidly increasing body of evidence, the German Cardiac Society has commissioned an update of its 2013 position paper on this topic. The German version was published in 2018 and the current manuscript is an extended translation of the original version. METHODS This position paper provides a synopsis of the state of knowledge regarding psychosocial factors in the most relevant cardiovascular diseases and gives recommendations with respect to their consideration in clinical practice. RESULTS Psychosocial factors such as low socioeconomic status, acute and chronic stress, depression, anxiety and low social support are associated with an unfavorable prognosis. Psychosocial problems and mental comorbidities should be assessed routinely to initiate targeted diagnostics and treatment. For all patients, treatment should consider age and gender differences as well as individual patient preferences. Multimodal treatment concepts should comprise education, physical exercise, motivational counseling and relaxation training or stress management. In cases of mental comorbidities, brief psychosocial interventions by primary care providers or cardiologists, regular psychotherapy and/or medications should be offered. While these interventions have positive effects on psychological symptoms, robust evidence for possible effects on cardiac outcomes is still lacking. CONCLUSIONS For coronary heart disease, chronic heart failure, arterial hypertension, and some arrhythmias, there is robust evidence supporting the relevance of psychosocial factors, pointing to a need for considering them in cardiological care. However, there are still shortcomings in implementing psychosocial treatment, and prognostic effects of psychotherapy and psychotropic drugs remain uncertain. There is a need for enhanced provider education and more treatment trials.
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Affiliation(s)
- Christian Albus
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Hilka Gunold
- Department of Cardiology, University Medical Center Leipzig, Leipzig, Germany
| | - Markus Haass
- Department of Cardiology, Angiology and Intensive Care, Theresienkrankenhaus, Mannheim, Germany
| | - Bettina Hamann
- Department of Psychocardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Homburg/Saar, Germany
| | - Volker Köllner
- Department of Psychosomatics and Behavioural Medicine, Seehof Rehabilitation Center, Teltow, Germany
| | - Boris Leithäuser
- Preventive Care Center, Cardiovascular Practice, Hamburg, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, Cardiology, Angiology and Intensive Care, University Hospital Aachen, Aachen, Germany
- For the Committee on Clinical Cardiovascular Medicine of the German Cardiac Society, Düsseldorf, Germany
| | - Malte Meesmann
- Department of Cardiology, Juliusspital, Würzburg, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Martin Scherer
- Institute and Clinic of General Practice and Primary Care, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Cora Stefanie Weber
- Department of Psychosomatic Medicine and Psychotherapy, Hennigsdorf Hospital, Hennigsdorf, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre and German Centre for Cardiovascular Research (DZHK), partner site, Göttingen, Germany
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13
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Neidenbach R, Achenbach S, Andonian C, Beckmann J, Biber S, Dittrich S, Ewert P, Freilinger S, Huntgeburth M, Nagdyman N, Oberhoffer R, Pieper L, von Kodolitsch Y, Weyand M, Bauer UMM, Kaemmerer H. [Medical care of adults with congenital heart diseases : Present and future]. Herz 2019; 44:553-572. [PMID: 31263905 DOI: 10.1007/s00059-019-4820-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Congenital heart diseases (CHD) are the most common types of congenital organ defects. Thanks to medical progress in congenital cardiology and heart surgery, most children with CHD reach adulthood. Despite primarily successful treatment residual and subsequent conditions as well as (non)cardiac comorbidities can influence the chronic course of the disease and lead to a higher morbidity and mortality. Adults with congenital heart disease (ACHD) in Germany are not tied to the healthcare structure despite the great need for aftercare. According to the results of the medical care of ACHD (MC-ACHD) study, ACHD centers and specialists in Germany are insufficiently perceived despite increased complication rates and the great need for specialist guidance. General practitioners and patients are not adequately informed about existing ACHD facilities. A better awareness of the ACHD problem should be created at the level of primary medical supply in order to optimize care and to reduce morbidity and mortality. Improved future-oriented patient care includes lifelong regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD.
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Affiliation(s)
- R Neidenbach
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland.
| | - S Achenbach
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - C Andonian
- Lehrstuhl für Sportpsychologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 60-62, 80992, München, Deutschland
| | - J Beckmann
- Lehrstuhl für Sportpsychologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 60-62, 80992, München, Deutschland
| | - S Biber
- Lehrstuhl für Sportpsychologie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Georg-Brauchle-Ring 60-62, 80992, München, Deutschland
| | - S Dittrich
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - P Ewert
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland
| | - S Freilinger
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland
| | - M Huntgeburth
- Klinik III für Innere Medizin, Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Herzzentrum, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - N Nagdyman
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland
| | - R Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992, München, Deutschland
| | - L Pieper
- Professur für behaviorale Epidemiologie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
| | - Y von Kodolitsch
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Weyand
- Medizinische Klinik 2, Kardiologie und Angiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - U M M Bauer
- Nationales Register für angeborene Herzfehler, Berlin, Deutschland
| | - H Kaemmerer
- Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland.
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Abstract
Certification is a critical component of quality assurance in medicine. From the certification of individual persons, through units and up to whole hospitals, certification stimulates testing and optimization of treatment processes, thereby improving the quality of care. Minimum case numbers needed to acquire a certificate are an important and objective attribute of quality. Advantages of certification include an improved treatment of patients, structured training of new employees and enhanced cost efficiency.
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Affiliation(s)
- M Halbach
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
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15
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16
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Neidenbach R, Schelling J, Pieper L, Sanftenberg L, Oberhoffer R, de Haan F, Weyand M, Schlensak C, Lossnitzer D, Nagdyman N, von Kodolitsch Y, Kallfelz HC, Helm PC, Bauer UMM, Ewert P, Meinertz T, Kaemmerer H. Sind Erwachsene mit angeborenen Herzfehlern ausreichend versorgt? ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-016-0134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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17
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Hauser M, Lummert E, Braun SL, Vigl M, Engelhardt A, Pujol C, Neidenbach RC, Oberhoffer R, Ewert P, Kaemmerer H. Nichtkardiale Komorbiditäten bei erwachsenen Patienten mit angeborenen Herzfehlern. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-016-0127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Helm PC, Kaemmerer H, Breithardt G, Sticker EJ, Keuchen R, Neidenbach R, Diller GP, Tutarel O, Bauer UMM. Transition in Patients with Congenital Heart Disease in Germany: Results of a Nationwide Patient Survey. Front Pediatr 2017; 5:115. [PMID: 28580351 PMCID: PMC5437851 DOI: 10.3389/fped.2017.00115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A growing number of adults with congenital heart disease (ACHD) pose a particular challenge for health care systems across the world. Upon turning into 18 years, under the German national health care system, ACHD patients are required to switch from a pediatric to an adult cardiologist or an ACHD-certified provider. To date, reliable data investigating the treatment situation of ACHD patients in Germany are not available. MATERIALS AND METHODS An online survey was conducted in collaboration with patient organizations to address the life situation and the conditions of health care provision for ACHD patients in Germany. ACHD patients were recruited from the database of the National Register for Congenital Heart Defects (NRCHD) and informed about the survey via email, websites, and social networks. A total of 1,828 ACHD patients (1,051 females) participated in this study. The mean age was 31.7 ± 11.7 years. Participants were surveyed about treating physicians and the institution mainly involved in the treatment of their CHD. In addition, participants were asked questions to assess the level of trust toward their treating physician and their familiarity with the term "ACHD-certified provider." RESULTS Among the surveyed patients, 25.4% stated that they attended a specific ACHD clinic at a heart center regularly, 32.7% were treated in a private practice setting by a pediatric cardiologist, 32.4% in a private practice (adult) cardiology setting, and 9.5% were treated by an "other physician." Only 24.4% of the male and 29.7% of the female ACHD patients were familiar with the term "ACHD-certified provider." CONCLUSION The transfer from pediatric cardiology to ACHD care requires further attention as many adult patients have not transferred to certified ACHD providers. The question of whether ACHD patients in Germany are offered consistent and adequate care should also be investigated in more detail. The answers regarding the ACHD certification are particularly disappointing and indicative of a large information gap and inadequate education in clinical practice.
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Affiliation(s)
- Paul C Helm
- National Register for Congenital Heart Defects, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Harald Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Günter Breithardt
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine University Hospital of Münster, Münster, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| | | | | | - Rhoia Neidenbach
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine University Hospital of Münster, Münster, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Oktay Tutarel
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
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Niggemeyer E. [Competence Network for Congenital Heart Defects: innovative research for a young patient group]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:497-505. [PMID: 26961866 DOI: 10.1007/s00103-016-2321-z] [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: 11/25/2022]
Abstract
BACKGROUND Congenital heart disease is the most frequent congenital malformation in humans and affects almost 1 % of all newborns. Thanks to advances in diagnostics and treatment, over 90 % of those affected reach adulthood today. Patient numbers are therefore growing constantly. The majority of those affected, however, remain chronically ill throughout life and require continuous specialized care. The spectrum of different clinical pictures is vast. Since this is a relatively young patient group, both research and care are lacking relevant knowledge and experience. OBJECTIVE The Competence Network for Congenital Heart Defects (CNCHD) was founded in 2003 to tackle the challenge of heterogeneity and accordingly small sample sizes by means of networked research. The following article offers an overview of the network and its mode of operation. MATERIAL AND METHODS The Germany-wide research network involves all relevant levels of research, public health care, the patient community and the general public. On the basis of a complex and flexible database infrastructure, it facilitates multicenter and interdisciplinary research in the field of congenital heart disease. RESULTS AND DISCUSSION The CNCHD succeeded in establishing research on congenital heart disease throughout Germany by providing a powerful research network and a suitable infrastructure. Scientists from across Germany and all over the world use this basis to jointly find answers to burning questions in the field of congenital heart disease.
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Affiliation(s)
- Eva Niggemeyer
- Kompetenznetz Angeborene Herzfehler e. V., Augustenburger Platz 1, 13353, Berlin, Deutschland.
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21
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Abstract
By improvement of the medical care, children with congenital heart disease survive in much greater numbers: the figure of ACHD-patients in Germany is estimated up to 203,000 to 301,000. The need for a specialized care of these patients is accepted by the scientific societies, who introduced a certification for doctors and centers and created guidelines. The medical problems include imaging, treatment of arrhythmia, congestive heart failure and cyanosis, prophylaxis of infectious endocarditis, exercise and pregnancy. For the most frequent defects, indication for treatment and postoperative care is summarized.
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[Recommendations on the structure of the care of adults with congenital heart disease (GUCH patients) in Austria -- update 2011th]. Wien Klin Wochenschr 2013; 125:755-8. [PMID: 24343043 DOI: 10.1007/s00508-013-0479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Indexed: 10/25/2022]
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[Adult patients with congenital heart disease]. Internist (Berl) 2013; 54:18, 20-7. [PMID: 23318541 DOI: 10.1007/s00108-012-3089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Unlike a few decades ago, today most patients with congenital heart disease reach adulthood after intervention or reparative surgery. As complete correction is generally not possible, a patient population with great complexity and a particular challenge to medical management is rising and a regular follow-up is mandatory. The aim of care is the timely recognition of residual or associated problems. Frequency and intensity of follow-up examinations depend on type and complexity of the lesion. The standard repertoire at follow-up consists of a specific history, clinical examination, ECG, Holter-monitoring, exercise tests, and echocardiography. Depending on the indication, cardio-MRI, CT scan, and sophisticated cardiac catheterization may become necessary. Long-term complications like rhythm disturbances, pulmonary hypertension, or heart failure are frequent, despite optimal care. Acute complications like arrhythmias, infective endocarditis, cerebral events, cerebral abscesses, aortic dissection, pulmonary embolism, and bleeding have to be recognized early and treated appropriately. Additional focus has to be placed on counseling and management of noncardiac disease and surgery, pregnancy and delivery, exercise at work and in private life, driving, and insurance issues. Training and certification of physicians as well as the establishment of specialized centers will help to ensure high quality health care for the affected patient population.
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Kaleschke G. Katheterinterventionelle Therapie bei Erwachsenen mit Herz- und Gefäßmissbildungen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-011-0885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Diller GP, Breithardt G, Baumgartner H. Congenital heart defects in adulthood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:452-9. [PMID: 21776319 PMCID: PMC3139408 DOI: 10.3238/arztebl.2011.0452] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/28/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND More than 90% of children with congenital heart defects now survive into adulthood; just a few decades ago, survival was rare, particularly among patients with complex defects. The new population of adults with congenital heart disease presents a special challenge to physicians from all of the involved specialties. METHODS Selective literature review. RESULTS AND CONCLUSION A complete cure of the congenital heart defect in childhood is exceptional, and most adult patients continue to suffer from residual problems and sequelae. Further surgery or catheter interventions may be needed. Potential late complications include arrhythmias, heart failure, pulmonary hypertension, endocarditis, and thromboembolic events. The management of these patients during pregnancy or non-cardiac surgery remains a challenge. If this evolving patient population is to receive the best possible care, the adequate provision of specialized medical services is a necessary, but not sufficient, condition: patients and their referring physicians will also need to be aware that these services are available, and then actually make use of them. Moreover, optimal communication among all of the involved physicians is essential.
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Affiliation(s)
- Gerhard-Paul Diller
- Kardiologisches Zentrum für Erwachsene mit angeborenen und erworbenen Herzfehlern (EMAH), Münster, Germany.
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Huber A, Prompona M, Kozlik-Feldmann R, Mühling O, Rummeny E, Reiser M, Theisen D. [MRI for therapy planning in patients with atrial septum defects]. Radiologe 2011; 51:31-7. [PMID: 21243461 DOI: 10.1007/s00117-010-1998-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to determine the value of a combined magnetic resonance imaging (MRI) protocol including steady-state free precession (SSFP) imaging, phase-contrast measurements and contrast-enhanced MR angiography (CE-MRA) for presurgical or preinterventional diagnostic imaging in patients with suspected atrial septum defects. MATERIAL AND METHODS Out of 65 MRI studies of patients with suspected atrial septum defects, 56 patients were included in the study. The atrial septum defects were identified on cine images. Velocity encoded flow measurements were used to determine shunt volumes, which were compared with invasive oxymetry in 24 patients. Contrast-enhanced MRI was used to assess the thoracic vessels in order to detect vascular anomalies. The findings were compared with the intraoperative results. RESULTS A total of 24 patients with high shunt volumes were treated either surgically (16 patients) or interventionally (8 patients) and 32 patients with low shunt volumes did not require surgical or interventional treatment. The vascular anomaly, which in all cases was anomalous pulmonary venous return, was confirmed by the intraoperative findings. The type and location of atrial septal defects which required treatment, were confirmed intraoperatively or during the intervention. The results of shunt quantification by MRI showed a good correlation with the results of invasive oximetry (r=0.91, p <0.0001). CONCLUSION A combined MRI protocol including cine SSFP images, velocity-encoded flow measurements and CE-MRA is an accurate method for preoperative and preinterventional evaluation of atrial septum defects.
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Affiliation(s)
- A Huber
- Institut für Radiologie, Technische Universität München, München, Deutschland.
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Kaemmerer H, Hess J. [Congenital heart disease. Transition from adolescence to adulthood]. Internist (Berl) 2010; 50:1221-2, 1224-7. [PMID: 19756442 DOI: 10.1007/s00108-009-2400-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a increasing clinical and scientific interest in adults with congenital heart disease. Germany is among, if not the first country worldwide, with a structured care of adults with congenital heart disease. Due to the advances in cardiology and in heart surgery, the primarily high mortality rate of relevant congenital heart disease has declined from 80% to less than 20% during the recent decades. Currently, in Europe the estimated number of adults with congenital heart disease is between 1.2 and 2.7 Mio., and the number in Germany exceeds 180,000. Almost all congenital heart defects, either native or interventionally or surgically treated, need regular control, since even after successful primary treatment significant residua or sequels have to be expected. Optimal care of these patients begins in the childhood and must be continued down to the high adulthood. The complexity of congenital heart defects makes a multidisciplinary approach necessary. A specialized, interdisciplinary cooperation between cardiologists, pediatric cardiologists, cardiac surgeons and other specialists is mandatory.
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Affiliation(s)
- H Kaemmerer
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, 80636 München.
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Moons P, Meijboom FJ, Baumgartner H, Trindade PT, Huyghe E, Kaemmerer H. Structure and activities of adult congenital heart disease programmes in Europe. Eur Heart J 2009; 31:1305-10. [DOI: 10.1093/eurheartj/ehp551] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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