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Cabrera Fernandez DL, Lopez KN, Bravo-Jaimes K, Mackie AS. The Impact of Social Determinants of Health on Transition From Pediatric to Adult Cardiology Care. Can J Cardiol 2024:S0828-282X(24)00291-5. [PMID: 38583706 DOI: 10.1016/j.cjca.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
Social determinants of health (SDoH) are the economic, social, environmental, and psychosocial factors that influence health. Adolescents and young adults with congenital heart disease (CHD) require lifelong cardiology follow-up and therefore coordinated transition from pediatric to adult healthcare systems. However, gaps in care are common during transition, and they are driven in part by pervasive disparities in SDoH, including race, ethnicity, socioeconomic status, access to insurance, and remote location of residence. These disparities often coexist and compound the challenges faced by patients and families. For example, Black and Indigenous individuals are more likely to be subject to systemic racism and implicit bias within healthcare and other settings, to be unemployed and poor, to have limited access to insurance, and to have a lower likelihood of transfer of care to adult CHD specialists. SDoH also are associated with acquired cardiovascular disease, a comorbidity that adults with CHD face. This review summarizes existing evidence regarding the impact of SDoH on the transition to adult care and proposes strategies at the individual, institutional, and population and/or system levels. to reduce inequities faced by transition-age youth. These strategies include routinely screening for SDoH in clinical settings with referral to appropriate services, providing formal transition education for all transition-age youth, including training on navigating complex medical systems, creating satellite cardiology clinics to facilitate access to care for those who live remote from tertiary centres, advocating for lifelong insurance coverage where applicable, mandating cultural-sensitivity training for providers, and increasing the diversity of healthcare providers in pediatric and adult CHD care.
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Affiliation(s)
- Diana L Cabrera Fernandez
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Keila N Lopez
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Mackie AS. Welcome Back! Returning to the Fold in Congenital Cardiology Care After Loss to Follow-up. Can J Cardiol 2024; 40:419-421. [PMID: 38056627 DOI: 10.1016/j.cjca.2023.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Marosi A, Conway J, Morgan C, Yaskina M, Foshaug R, Chappell A, Ryerson L, Martin BJ, Ash A, Al-Aklabi M, Myers K, Mackie AS. Acute kidney injury and renal recovery following Fontan surgery. JTCVS Open 2024; 17:248-256. [PMID: 38420533 PMCID: PMC10897650 DOI: 10.1016/j.xjon.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024]
Abstract
Objectives Acute kidney injury has been described after Fontan surgery, but the duration and outcomes are unknown. We sought to describe the incidence of and risk factors for acute kidney injury and the phenotype of renal recovery, and evaluate the impact of renal recovery phenotype on outcomes. Methods All children who underwent a Fontan operation at a single center between 2009 and 2022 were included. Data collected included Fontan characteristics, vasopressor use, all measures of creatinine, and postoperative outcomes. Logistic regression models were used to assess predictors of acute kidney injury and the association between acute kidney injury and outcomes. Results We enrolled 141 children (45% female). Acute kidney injury occurred in 100 patients (71%). Acute kidney injury duration was transient (<48 hours) in 77 patients (55%), persistent (2-7 days) in 15 patients (11%), more than 7 days in 4 patients (3%), and unknown in 4 patients (3%). Risk factors for acute kidney injury included higher preoperative indexed pulmonary vascular resistance (odds ratio, 3.90; P = .004) and higher postoperative inotrope score on day 0 (odds ratio, 1.13, P = .047). Risk factors for acute kidney injury duration more than 48 hours included absence of a fenestration (odds ratio, 3.43, P = .03) and longer duration of cardiopulmonary bypass (odds ratio, 1.22 per 15-minute interval, P = .01). Acute kidney injury duration more than 48 hours was associated with longer length of stay compared with transient acute kidney injury (median 18 days [interquartile range, 9-62] vs 10 days [interquartile range, 8-16], P = .006) and more sternal wound infections (17% vs 4%, P = .049). Conclusions Acute kidney injury after the Fontan operation is common. The occurrence and duration of acute kidney injury have significant implications for postoperative outcomes.
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Affiliation(s)
- Anna Marosi
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Morgan
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rae Foshaug
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Alyssa Chappell
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay Ryerson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Billie-Jean Martin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Alanna Ash
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Mohammed Al-Aklabi
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Myers
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Smith C, Olugbuyi O, Kaul P, Dover DC, Mackie AS, Islam S, Eckersley L, Hornberger LK. Lower Socioeconomic Status is Associated with an Increased Incidence and Spectrum of Major Congenital Heart Disease and Associated Extracardiac Pathology. Pediatr Cardiol 2024; 45:433-440. [PMID: 37870603 DOI: 10.1007/s00246-023-03310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
Several studies have suggested an inverse relationship between lower socioeconomic status (SES) and the incidence of congenital heart disease (CHD) among live births. We sought to examine this relationship further in a Canada-wide population study, exploring CHD subtypes, trends, and associated noncardiac abnormalities. Infants born in Canada (less Quebec) from 2008 to 2018 with CHD requiring intervention in the first year were identified using ICD-10 codes through the Canadian Institute for Health Information Discharge Abstract Database. Births of CHD patients were stratified by SES (census-based income quintiles) and compared against national birth proportions using X2 tests. Proportions with extracardiac defects (ED) and nonlethal genetic syndromes (GS) were also explored. From 2008 to 2018, 7711 infants born with CHD were included. The proportions of major CHD distributed across SES quintiles were 27.1%, 20.1%, 19.2%, 18.6%, and 15.0% from lowest to highest, with significant differences relative to national birth proportions (22.0%, 20.0%, 20.6%, 20.7%, and 16.7% from lowest (1) to highest (5)) (p < 0.0001). No temporal trends in the CHD proportions across SES categories were observed over the study period. The distribution across SES quintiles was different only for specific CHD subtypes (double-outlet right ventricle (n = 485, p = 0.03), hypoplastic left heart syndrome (n = 547, p = 0.006), heterotaxy (n = 224, p = 0.03), tetralogy of Fallot (n = 1007, p = 0.008), truncus arteriosus (n = 126, p < 0.0001), and ventricular septal defect (n = 1916, p < 0.0001)), with highest proportions observed in the lowest quintile. The proportion of the total population with ED but not GS was highest in lower SES quintiles (< 0.0001) commensurate with increased proportion of CHD. Our study suggests a negative association between SES and certain CHD lesions and ED.
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Affiliation(s)
- Christopher Smith
- School of Public Health, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Oluwayomi Olugbuyi
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Padma Kaul
- School of Public Health, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Andrew S Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Luke Eckersley
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- Department of Obstetrics & Gynecology, Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada.
- Pediatric Cardiology, Stollery Children's Hospital, 4C2, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada.
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Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Estensen ME, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Jameson SM, Callus E, Kutty S, Oechslin E, Van Bulck L, Moons P. Anxiety and Depression in Adults With Congenital Heart Disease. J Am Coll Cardiol 2024; 83:430-441. [PMID: 38233017 DOI: 10.1016/j.jacc.2023.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND A comprehensive understanding of adult congenital heart disease outcomes must include psychological functioning. Our multisite study offered the opportunity to explore depression and anxiety symptoms within a global sample. OBJECTIVES In this substudy of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study), the authors we investigated the prevalence of elevated depression and anxiety symptoms, explored associated sociodemographic and medical factors, and examined how quality of life (QOL) and health status (HS) differ according to the degree of psychological symptoms. METHODS Participants completed the Hospital Anxiety and Depression Scale, which includes subscales for symptoms of anxiety (HADS-A) and depression (HADS-D). Subscale scores of 8 or higher indicate clinically elevated symptoms and can be further categorized as mild, moderate, or severe. Participants also completed analogue scales on a scale of 0 to 100 for QOL and HS. Analysis of variance was performed to investigate whether QOL and HS differed by symptom category. RESULTS Of 3,815 participants from 15 countries (age 34.8 ± 12.9 years; 52.7% female), 1,148 (30.1%) had elevated symptoms in one or both subscales: elevated HADS-A only (18.3%), elevated HADS-D only (2.9%), or elevations on both subscales (8.9%). Percentages varied among countries. Both QOL and HS decreased in accordance with increasing HADS-A and HADS-D symptom categories (P < 0.001). CONCLUSIONS In this global sample of adults with congenital heart disease, almost one-third reported elevated symptoms of depression and/or anxiety, which in turn were associated with lower QOL and HS. We strongly advocate for the implementation of strategies to recognize and manage psychological distress in clinical settings. (Patient-Reported Outcomes in Adults With Congenital Heart Disease [APPROACH-IS]; NCT02150603).
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Affiliation(s)
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Education, Toyo University, Tokyo, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- IU Health Adult Congenital Heart Disease Program, IU School of Medicine, Indianapolis, Indiana, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Mette-Elise Estensen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Department of Health Sciences, University West, Trollhättan, Sweden; The Queen Silva Children's Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samuel Menahem
- Department of Paediatrics and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexandra Soufi
- Department of Cardiac Rehabilitation, Médipôle Hôpital Mutualiste, Lyon-Villeurbanne, France
| | - Susan M Jameson
- Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, California, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Hasan MS, Ganni E, Liu A, Guo L, Mackie AS, Kaufman JS, Marelli AJ. CanCHD Study of Hematopoietic Cancers in Children With and Without Genetic Syndromes. J Am Heart Assoc 2024; 13:e026604. [PMID: 38156460 PMCID: PMC10863797 DOI: 10.1161/jaha.122.026604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Individuals with genetic syndromes can manifest both congenital heart disease (CHD) and cancer attributable to possible common underlying pathways. To date, reliable risk estimates of hematopoietic cancer (HC) among children with CHD based on large population-based data remain scant. This study sought to quantify the risk of HC by the presence of genetic syndrome among children with CHD. METHODS AND RESULTS Data sources were the Canadian CHD database, a nationwide database on CHD (1999-2017), and the CCR (Canadian Cancer Registry). Standardized incidence ratios were calculated for comparing HC incidences in children with CHD with the general pediatric population. A modified Kaplan-Meier curve was used to estimate the cumulative incidence of HC with death as a competing risk. A total of 143 794 children (aged 0-17 years) with CHD were followed up from birth to age 18 years for 1 314 603 person-years. Of them, 8.6% had genetic syndromes, and 898 HC cases were observed. Children with known syndromes had a substantially higher risk of incident HC than the general pediatric population (standardized incidence ratio, 13.4 [95% CI, 11.7-15.1]). The cumulative incidence of HC was 2.44% (95% CI, 2.11-2.76) among children with a syndrome and 0.79% (95% CI, 0.72-0.87) among children without a syndrome. Acute myeloid leukemia had a higher cumulative incidence during early childhood than acute lymphoblastic leukemia. CONCLUSIONS This is the first large population-based analysis documenting that known genetic syndromes in children with CHD are a significant predictor of HC. The finding could be essential in informing risk-stratified policy recommendations for cancer surveillance in children with CHD.
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Affiliation(s)
- Mohammad Sazzad Hasan
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Elie Ganni
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Liming Guo
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Andrew S. Mackie
- Division of Cardiology, Stollery Children’s Hospital and Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Ariane J. Marelli
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
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Edelson JB, Zak V, Goldberg D, Fleming G, Mackie AS, Patel JK, Files M, Downing T, Richmond M, Acheampong B, Cartoski M, Detterich J, McCrindle B, McHugh K, Hansen JE, Wagner J, Maria MD, Weingarten A, Nowlen T, Yoon JK, Kim GB, Williams R, Whitehill R, Kirkpatrick E, Yin S, Ermis P, Lubert AM, Stylianou M, Freemon D, Hu C, Garuba OD, Frommelt P, Goldstein BH, Paridon S, Garg R. The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation. Am J Cardiol 2024; 210:183-187. [PMID: 37918818 PMCID: PMC10872492 DOI: 10.1016/j.amjcard.2023.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 11/04/2023]
Abstract
The Fontan Udenafil Exercise Longitudinal (FUEL) trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n = 200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p = 0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | | | - David Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Greg Fleming
- Duke Children's Pediatric and Congenital Heart Center, Durham, North Carolina
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, California
| | - Jyoti K Patel
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Files
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Tacy Downing
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia
| | - Marc Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Ben Acheampong
- Children's Hospital and Medical Center, University of Nebraska, Omaha, Nebraska
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Brian McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kimberly McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Jesse E Hansen
- Division of Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Wagner
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, Missouri; Division of Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michael Di Maria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Angela Weingarten
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Ja Kyoung Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Richard Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Robert Whitehill
- Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Edward Kirkpatrick
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Suellen Yin
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Peter Ermis
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Adam M Lubert
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mario Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | - D'Andrea Freemon
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Olukayode D Garuba
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Peter Frommelt
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ruchira Garg
- Departments of Cardiology and Pediatrics, Cedars-Sinai Guerin Children's and Smidt Heart Institute, Los Angeles, California
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Patzer J, Yaskina M, Chappell A, Patton D, Alvarez N, Dicke F, Mackie AS. Patient factors and geographic barriers influencing excess time between paediatric and adult CHD care. Cardiol Young 2023:1-8. [PMID: 38149823 DOI: 10.1017/s1047951123004250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Over 90% of children with CHD survive into adulthood and require lifelong cardiology care. Delays in care predispose patients to cardiac complications. We sought to determine the time interval to accessing adult CHD care beyond what was recommended by the referring paediatric cardiologist (excess time) and determine risk factors for prolonged excess time. MATERIALS AND METHODS Retrospective cohort study including all patients in the province of Alberta, Canada, age 16-18 years at their last paediatric cardiology visit, with moderate or complex lesions. Excess time between paediatric and adult care was defined as the interval (months) between the final paediatric visit and the first adult visit, minus the recommended interval between these appointments. Patients whose first adult CHD appointment occurred earlier than the recommended interval were assigned an excess time of zero. RESULTS We included 286 patients (66% male, mean age 17.6 years). Mean excess time was 7.9 ± 15.9 months. Twenty-nine (10%) had an excess time > 24 months. Not having a pacemaker (p = 0.03) and not needing cardiac medications at transfer (p = 0.02) were risk factors for excess time >3 months. Excess time was not influenced by CHD complexity. DISCUSSION The mean delay to first adult CHD appointment was almost 8 months longer than recommended by referring paediatric cardiologists. Not having a pacemaker and not needing cardiac medication(s) were risk factors for excess time > 3 months. Greater outpatient resources are required to accommodate the growing number of adult CHD survivors.
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Affiliation(s)
- Jessica Patzer
- Section of Cardiology, Department of Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Alyssa Chappell
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - David Patton
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Nanette Alvarez
- Section of Cardiology, Department of Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Frank Dicke
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Andrew S Mackie
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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9
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Goldberg DJ, Hu C, Lubert AM, Rathod RH, Penny DJ, Petit CJ, Schumacher KR, Ginde S, Williams RV, Yoon JK, Kim GB, Nowlen TT, DiMaria MV, Frischhertz BP, Wagner JB, McHugh KE, McCrindle BW, Cartoski MJ, Detterich JA, Yetman AT, John AS, Richmond ME, Yung D, Payne RM, Mackie AS, Davis CK, Shahanavaz S, Hill KD, Almaguer M, Zak V, McBride MG, Goldstein BH, Pearson GD, Paridon SM. The Fontan Udenafil Exercise Longitudinal Trial: Subgroup Analysis. Pediatr Cardiol 2023; 44:1691-1701. [PMID: 37382636 DOI: 10.1007/s00246-023-03204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Abstract
The Pediatric Heart Network's Fontan Udenafil Exercise Longitudinal (FUEL) Trial (Mezzion Pharma Co. Ltd., NCT02741115) demonstrated improvements in some measures of exercise capacity and in the myocardial performance index following 6 months of treatment with udenafil (87.5 mg twice daily). In this post hoc analysis, we evaluate whether subgroups within the population experienced a differential effect on exercise performance in response to treatment. The effect of udenafil on exercise was evaluated within subgroups defined by baseline characteristics, including peak oxygen consumption (VO2), serum brain-type natriuretic peptide level, weight, race, gender, and ventricular morphology. Differences among subgroups were evaluated using ANCOVA modeling with fixed factors for treatment arm and subgroup and the interaction between treatment arm and subgroup. Within-subgroup analyses demonstrated trends toward quantitative improvements in peak VO2, work rate at the ventilatory anaerobic threshold (VAT), VO2 at VAT, and ventilatory efficiency (VE/VCO2) for those randomized to udenafil compared to placebo in nearly all subgroups. There was no identified differential response to udenafil based on baseline peak VO2, baseline BNP level, weight, race and ethnicity, gender, or ventricular morphology, although participants in the lowest tertile of baseline peak VO2 trended toward larger improvements. The absence of a differential response across subgroups in response to treatment with udenafil suggests that the treatment benefit may not be restricted to specific sub-populations. Further work is warranted to confirm the potential benefit of udenafil and to evaluate the long-term tolerability and safety of treatment and to determine the impact of udenafil on the development of other morbidities related to the Fontan circulation.Trial Registration NCT0274115.
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Affiliation(s)
- David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | | | - Adam M Lubert
- Cincinnati Children's Hospital and Medical Center, Heart Institute, Cincinnati, OH, 45229, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Daniel J Penny
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Kurt R Schumacher
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Salil Ginde
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, 53226, USA
| | - Richard V Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, 84132, USA
| | - J K Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University School of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Todd T Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Michael V DiMaria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Benjamin P Frischhertz
- Division of Cardiology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Jonathan B Wagner
- Divisions of Cardiology and Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
| | - Kimberly E McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Mark J Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, DE, 19803, USA
| | - Jon A Detterich
- Division of Cardiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, 90027, USA
| | - Anji T Yetman
- Children's Hospital and Medical Center, University of Nebraska, Omaha, NE, 68114, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, 20010, USA
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Delphine Yung
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - R Mark Payne
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Christopher K Davis
- Division of Cardiology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, 92123, USA
| | - Shabana Shahanavaz
- Division of Cardiology, St. Louis Children's Hospital, St. Louis, MO, 63110, USA
| | - Kevin D Hill
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC, 27705, USA
| | - Marisa Almaguer
- Cincinnati Children's Hospital and Medical Center, Heart Institute, Cincinnati, OH, 45229, USA
| | | | - Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, 20892, USA
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
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Allemang B, Samuel S, Greer K, Schofield K, Pintson K, Patton M, Farias M, Sitter KC, Patten SB, Mackie AS, Dimitropoulos G. Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study. Health Expect 2023; 26:2228-2244. [PMID: 37452518 PMCID: PMC10632650 DOI: 10.1111/hex.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown. OBJECTIVE The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained from participants completing the Transition Readiness Assessment Questionnaire (TRAQ) and qualitative data. DESIGN AND PARTICIPANTS A three-phase sequential explanatory mixed methods design was employed, with the qualitative strand taking priority. First, the TRAQ scores (range 1-5) of youth with co-occurring conditions (n = 61) enroled in a multisite randomized controlled trial were measured, followed by qualitative interviews with a sample of youth (n = 9) to explain the quantitative results. Results from both strands were then integrated, yielding comprehensive insights. RESULTS Median TRAQ scores ranged from 2.86 on the appointment keeping subscale to 5.00 on the talking with providers subscale. The qualitative results uncovered the complexities faced by this group concerning the impact of a mental health comorbidity on transition readiness and self-management skills across TRAQ domains. The integrated findings identified a diverse and highly individualized set of strengths and challenges amongst this group that did not align with overarching patterns as measured by the TRAQ. CONCLUSIONS This mixed methods study generated novel understandings about how youth with co-occurring conditions develop competencies related to self-care, self-advocacy and self-management in preparation for paediatric-adult service transitions. Results demonstrated the assessment of transition readiness using a generic scale does not address the nuanced and complex needs of youth with co-occurring chronic health and mental health conditions. Our findings suggest tailoring transition readiness practices for this group based on youths' own goals, symptoms, coping mechanisms and resources. PATIENT OR PUBLIC INVOLVEMENT This study was conducted in collaboration with five young adult research partners (YARP) with lived experience transitioning from paediatric to adult health/mental health services. The YARP's contributions across study phases ensured the perspectives of young people were centred throughout data collection, analysis, interpretation and presentation of findings. All five YARP co-authored this manuscript.
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Affiliation(s)
- Brooke Allemang
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Katelyn Greer
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Karina Pintson
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | - Megan Patton
- Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Marcela Farias
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Scott B. Patten
- Department of Psychiatry, Mathison Centre for Mental Health Research and EducationUniversity of CalgaryCalgaryAlbertaCanada
- Department of Psychiatry, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrew S. Mackie
- Department of PediatricsStollery Children's HospitalEdmontonAlbertaCanada
| | - Gina Dimitropoulos
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
- Department of Psychiatry, Mathison Centre for Mental Health Research and EducationUniversity of CalgaryCalgaryAlbertaCanada
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11
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC Pediatr Congenit Heart Dis 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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12
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Han A, Gingrich J, Yaskina M, Rankin K, San Martin-Feeney D, Mackie AS. Just TRAC it! Transitioning Responsibly to Adult Care Using Smart Phone Technology. J Adolesc Health 2023; 73:561-566. [PMID: 37306646 DOI: 10.1016/j.jadohealth.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE There is little evidence on whether smartphone technology influences transition readiness among adolescents with heart disease. Just TRAC it! is a method of using existing smartphone features (Notes, Calendar, Contacts, Camera) to manage personal health. We evaluated the impact of Just TRAC it! on self-management skills. METHODS Randomized clinical trial of 16-18 year-olds with heart disease. Participants were randomly allocated 1:1 to either usual care (education session) or intervention (education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! Analysis was intention-to-treat. RESULTS We enrolled 68 patients (41% female, mean age 17.3 years), 68% having previous cardiac surgery and 26% had cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups but were not significantly different between groups. Each additional point at the baseline score brought, on average, a 0.7-point increase in TRANSITION-Q score (95% CI 0.5-0.9) at each of 3 and 6 months. The Camera, Calendar and Notes apps were reported as most useful. All intervention participants would recommend Just TRAC it! to others. DISCUSSION A nurse-led transition teaching with versus without Just TRAC it! improved transition readiness, with no significant difference between groups. Higher baseline TRANSITION-Q scores were associated with greater increase in scores over time. Participants had a positive reception to Just TRAC it! and would recommend it to others. Smartphone technology may be useful in transition education.
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Affiliation(s)
- Angela Han
- Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jody Gingrich
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Kathryn Rankin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andrew S Mackie
- Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
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13
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Sheridan JA, Noga M, Mackie AS. Congenital Disorders of the Pericardium. Can J Cardiol 2023; 39:1140-1143. [PMID: 36931623 DOI: 10.1016/j.cjca.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Affiliation(s)
- Jared A Sheridan
- Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Noga
- Stollery Children's Hospital and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew S Mackie
- Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Rehman JK, Rempel GR, Williams E, Meakins L, Bauman ME, Massicotte MP, Davis R, Dahl J, Mackie AS. Evaluation of a Video-Based Education Intervention for Parents of Children Undergoing Fontan Surgery: A Cluster Randomized Controlled Trial. CJC Pediatr Congenit Heart Dis 2023; 2:176-186. [PMID: 37969858 PMCID: PMC10642087 DOI: 10.1016/j.cjcpc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/04/2023] [Indexed: 11/17/2023]
Abstract
Background Fontan surgery is performed at 2-4 years of age and is the third planned surgical intervention for children with a univentricular heart. Major challenges for children and parents after Fontan include (a) psychological distress, (b) prolonged pleural drainage, and (c) the need for postoperative anticoagulation. The aim of this study was to evaluate a pre-Fontan video-based intervention for parents to address these challenges. Methods This study is a single-centre mixed-methods cluster randomized controlled trial. The intervention consisted of 3 brief whiteboard videos offered online from preadmission clinic to 1 month postoperatively. The parent's State Trait Anxiety Inventory score and the child's Post Hospital Behaviour Questionnaire score were measured 1 week and 1 month postoperatively. Semistructured interviews were conducted to obtain parental feedback on the videos. Results We enrolled 26 children (13 female patients; 16 intervention group) and 1 parent per child. Mean State Trait Anxiety Inventory scores were similar between groups at both 1 week (52.8 vs 55.5, P = 0.25) and 1 month postoperatively (50.9 vs 53.9, P = 0.25). Post Hospital Behaviour Questionnaire scores were in the maladaptive range but did not differ between groups. Parents agreed or strongly agreed that the videos were helpful but should be provided earlier in the preoperative process. The main value of the videos was recognized as being a method for standardizing information provided to parents. Conclusions A video-based education intervention did not impact State Trait Anxiety Inventory or Post Hospital Behaviour Questionnaire scores. However, the majority of parents agreed that the videos were helpful.
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Affiliation(s)
- Julie K. Rehman
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Gwen R. Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Elina Williams
- Western Canadian Children’s Heart Network, Edmonton, Alberta, Canada
| | | | | | - M. Patricia Massicotte
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Roberta Davis
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Judy Dahl
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Andrew S. Mackie
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Allemang B, Samuel S, Pintson K, Patton M, Greer K, Farias M, Schofield K, Sitter KC, Patten SB, Mackie AS, Dimitropoulos G. "They go hand in hand": a patient-oriented, qualitative descriptive study on the interconnectedness between chronic health and mental health conditions in transition-age youth. BMC Health Serv Res 2023; 23:2. [PMID: 36593502 PMCID: PMC9809059 DOI: 10.1186/s12913-022-09002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Transition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions. METHODS TAY (aged 16-20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems. RESULTS Participants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) "they're intertwined": connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY. CONCLUSIONS Our findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.
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Affiliation(s)
- Brooke Allemang
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada
| | - Susan Samuel
- grid.22072.350000 0004 1936 7697Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3300 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Karina Pintson
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada
| | - Megan Patton
- grid.22072.350000 0004 1936 7697Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3300 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Katelyn Greer
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada
| | - Marcela Farias
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada
| | - Keighley Schofield
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada
| | - Kathleen C. Sitter
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada
| | - Scott B. Patten
- grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3300 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Andrew S. Mackie
- grid.416656.60000 0004 0633 3703Department of Pediatrics, Stollery Children’s Hospital, 84400 112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Gina Dimitropoulos
- grid.22072.350000 0004 1936 7697Faculty of Social Work, University of Calgary, MacKimmie Tower, 400-B3, 2500 University Drive, NW, Calgary, AB T2N 1N4 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
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Sekhon R, Foshaug RR, Kantor PF, Mansukhani G, Mackie AS, Hollander SA, Lewis K, Conway J. Incidence and impact of malnutrition in patients with Fontan physiology. JPEN J Parenter Enteral Nutr 2023; 47:59-66. [PMID: 35932247 DOI: 10.1002/jpen.2437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Single-ventricle patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in several long-term complications, but the impact and consequences of nutrition status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on outcomes. METHODS This study was a retrospective cohort study of children who underwent Fontan surgery between 1997 and 2018. Clinical, demographic, and nutrition data were collected, including weight, height, body mass index (BMI), and their respective z scores (z score for weight-for-age [WAZ], z score for height-for-age [HAZ], and z score for BMI-for-age [BMIZ]) pre-Fontan, at discharge, 6 months, and 1, 5, and 10 years post-Fontan. Malnutrition status was categorized using the American Society for Parenteral and Enteral Nutrition guidelines and the Michigan MTool. Fontan failure was defined as listing for heart transplant or death. RESULTS Of the 69 patients, moderate-severe malnutrition occurred at any time point in 11% (n = 8) by WAZ, 16% (n = 11) by HAZ, and 6% (n = 4) by BMIZ. Moderate-severe malnutrition persisted in 6.5%-12.9% at 10 years post-Fontan. Compared with the pre-Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre-Fontan malnutrition. CONCLUSION There is a 6%-16% incidence of moderate-severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in follow-up. There was no association with anthropometric parameters and transplant-free survival. A prospective multi-institutional study is needed to understand the impact of malnutrition on long-term outcomes.
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Affiliation(s)
- Ravneet Sekhon
- Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Rae R Foshaug
- Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Paul F Kantor
- Department of Pediatric Cardiology, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Gitanjali Mansukhani
- Division of Pediatric Cardiology, Department of Pediatrics, LHSC Children's Hospital, Western University, London, Ontario, Canada
| | - Andrew S Mackie
- Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Seth A Hollander
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Kylie Lewis
- Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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17
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Meakins LT, Knox P, Legge L, Penner M, Wiebe P, Mackie AS. Interstage mortality among infants with hypoplastic left heart syndrome: Outcomes of a multicentre home monitoring program. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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18
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Di Maria MV, Goldberg DJ, Zak V, Hu C, Lubert AM, Dragulescu A, Mackie AS, McCrary A, Weingarten A, Parthiban A, Goot B, Goldstein BH, Taylor C, Lindblade C, Petit C, Spurney C, Harrild D, Urbina EM, Schuchardt E, Kim GB, Yoon JK, Colombo JN, Files M, Schoessling M, Ermis P, Wong P, Garg R, Swanson S, Menon S, Srivastava S, Thorsson T, Johnson TR, Krishnan US, Paridon SM, Frommelt PC. Impact of Udenafil on Echocardiographic Indices of Single Ventricle Size and Function in FUEL Study Participants. Circ Cardiovasc Imaging 2022; 15:e013676. [PMID: 36378780 PMCID: PMC9674374 DOI: 10.1161/circimaging.121.013676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The FUEL trial (Fontan Udenafil Exercise Longitudinal) demonstrated statistical improvements in exercise capacity following 6 months of treatment with udenafil (87.5 mg po BID). The effect of udenafil on echocardiographic measures of single ventricle function in this cohort has not been studied. METHODS The 400 enrolled participants were randomized 1:1 to udenafil or placebo. Protocol echocardiograms were obtained at baseline and 26 weeks after initiation of udenafil/placebo. Linear regression compared change from baseline indices of single ventricle systolic, diastolic and global function, atrioventricular valve regurgitation, and mean Fontan fenestration gradient in the udenafil cohort versus placebo, controlling for ventricular morphology (left ventricle versus right ventricle/other) and baseline value. RESULTS The udenafil participants (n=191) had significantly improved between baseline and 26 weeks visits compared to placebo participants (n=195) in myocardial performance index (P=0.03, adjusted mean difference [SE] of changes between groups -0.03[0.01]), atrioventricular valve inflow peak E (P=0.009, 3.95 [1.50]), and A velocities (P=0.034, 3.46 [1.62]), and annular Doppler tissue imaging-derived peak e' velocity (P=0.008, 0.60[0.23]). There were no significant differences in change in single ventricle size, systolic function, atrioventricular valve regurgitation severity, or mean fenestration gradient. Participants with a dominant left ventricle had significantly more favorable baseline values of indices of single ventricle size and function (lower volumes and areas, E/e' ratio, systolic:diastolic time and atrioventricular valve regurgitation, and higher annular s' and e' velocity). CONCLUSIONS FUEL participants who received udenafil demonstrated a statistically significant improvement in some global and diastolic echo indices. Although small, the changes in diastolic function suggest improvement in pulmonary venous return and/or augmented ventricular compliance, which may help explain improved exercise performance in that cohort. REGISTRATION URL: https://clinicaltrials.gov; Unique Identifier: NCT02741115.
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Affiliation(s)
- Michael V. Di Maria
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - David J. Goldberg
- Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | | | - Adam M. Lubert
- Cincinnati Children’s Hospital, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Andrew S. Mackie
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canana
| | | | | | - Anitha Parthiban
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Benjamin Goot
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Bryan H. Goldstein
- Cincinnati Children’s Hospital, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Carolyn Taylor
- Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC
| | | | - Christopher Petit
- Children’s Heart Center, Emory University School of Medicine, Atlanta, GA
| | | | | | - Elaine M. Urbina
- Cincinnati Children’s Hospital, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Eleanor Schuchardt
- Rady Children’s Hospital, University of California San Diego, San Diego, CA
| | - Gi Beom Kim
- Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Kyoung Yoon
- Sejong Hospital Cardiovascular Center, Department of Pediatrics, Bucheon, South Korea
| | - Jamie N. Colombo
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO
| | - Matthew Files
- Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Megan Schoessling
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Peter Ermis
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Pierre Wong
- Children’s Hospital of Los Angeles, Keck School of Medicine of USC, Los Angeles, CA
| | - Ruchira Garg
- Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA
| | - Sara Swanson
- Children’s Hospital and Medical Center, Omaha, NE
| | - Shaji Menon
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT
| | | | - Thor Thorsson
- C.S. Mott Children’s Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI
| | | | - Usha S. Krishnan
- Columbia University Irving Medical Center, Morgan Stanley Children’s Hospital of New York, New York, NY
| | - Stephen M Paridon
- Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Peter C. Frommelt
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
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19
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Allemang B, Dimitropoulos G, Patten SB, Sitter KC, Brobbey A, Mackie AS, Samuel S. Association between transition readiness and mental health comorbidity in youth with chronic health conditions. J Pediatr Nurs 2022; 67:161-167. [PMID: 36152476 DOI: 10.1016/j.pedn.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Between 33 and 59% of youth with chronic health conditions experience mental health conditions. Transition readiness, or the acquisition of knowledge and self-management skills, facilitates successful transition to adult care. Transition readiness among youth with co-occurring chronic health and mental health conditions has not been explored. DESIGN AND METHODS This study used a sample of 201 patients (aged 16-21) with chronic conditions. All patients completed the Transition Readiness Assessment Questionniare (TRAQ) and were grouped into Cohort A: chronic health conditions only (n = 140), and Cohort B: co-occurring chronic health and mental health conditions (n = 61). A quantile regression at the 50th percentile was conducted to examine associations between TRAQ score and mental health comorbidity, age, gender and immigration status. RESULTS The median TRAQ score for Cohort A was 3.87 (IQR 0.84) versus 4.00 (IQR 0.87) for Cohort B. Our analysis revealed that having a mental health comorbidity (b = 0.402, p = 0.034), being older in age (b = 0.540, p = 0.004) and being female (b = 0.388, p = 0.001) were associated with higher overall TRAQ score. CONCLUSIONS The presence of a mental health comorbidity was associated with greater transition readiness as measured by the TRAQ in our sample. Future research should explore why youth with co-occurring chronic health and mental health conditions exhibit greater transition readiness. PRACTICE IMPLICATIONS Youth with co-occurring chronic health and mental health conditions may develop transition readiness as a result of coping with mental health challenges. Practitioners could invite them to reflect on how their physical and mental health are related and affect their level of preparedness for adult care.
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Affiliation(s)
- Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen C Sitter
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Anita Brobbey
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew S Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Samuel
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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20
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Olugbuyi O, Smith C, Kaul P, Dover DC, Mackie AS, Islam S, Eckersley L, Hornberger LK. Impact of Socioeconomic Status and Residence Distance on Infant Heart Disease Outcomes in Canada. J Am Heart Assoc 2022; 11:e026627. [PMID: 36073651 DOI: 10.1161/jaha.122.026627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Socioeconomic status (SES) impacts clinical outcomes associated with severe congenital heart disease (sCHD). We examined the impact of SES and remoteness of residence (RoR) on congenital heart disease (CHD) outcomes in Canada, a jurisdiction with universal health insurance. Methods and Results All infants born in Canada (excluding Quebec) from 2008 to 2018 and hospitalized with CHD requiring intervention in the first year were identified. Neighborhood level SES income quintiles were calculated, and RoR was categorized as residing <100 km, 100 to 299 km, or >300 km from the closest of 7 cardiac surgical programs. In-hospital mortality at <1 year was the primary outcome, adjusted for preterm birth, low birth weight, and extracardiac pathology. Among 7711 infants, 4485 (58.2%) had moderate CHD (mCHD) and 3226 (41.8%) had sCHD. Overall mortality rate was 10.5%, with higher rates in sCHD than mCHD (13.3% versus 8.5%, respectively). More CHD infants were in the lowest compared with the highest SES category (27.1% versus 15.0%, respectively). The distribution of CHD across RoR categories was 52.3%, 21.3%, and 26.4% for <100 km, 100 to 299 km, and >300 km, respectively. Although SES and RoR had no impact on sCHD mortality, infants with mCHD living >300 km had a higher risk of mortality relative to those living <100 km (adjusted odds ratio [aOR], 1.43 [95% CI, 1.11-1.84]). Infants with mCHD within the lowest SES quintile and living farthest away had the highest risk for mortality (aOR, 1.74 [95% CI, 1.08-2.81]). Conclusions In Canada, neither RoR nor SES had an impact on outcomes of infants with sCHD. Greater RoR, however, may contribute to higher risk of mortality among infants with mCHD.
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Affiliation(s)
- Oluwayomi Olugbuyi
- Division of Cardiology Department of Pediatrics, University of Alberta Edmonton Alberta Canada
| | - Christopher Smith
- School of Public Health University of Alberta Edmonton Alberta Canada.,Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada
| | - Padma Kaul
- School of Public Health University of Alberta Edmonton Alberta Canada.,Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada.,Department of Medicine University of Alberta Edmonton Alberta Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada
| | - Andrew S Mackie
- Division of Cardiology Department of Pediatrics, University of Alberta Edmonton Alberta Canada
| | - Sunjidatul Islam
- Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada
| | - Luke Eckersley
- Division of Cardiology Department of Pediatrics, University of Alberta Edmonton Alberta Canada
| | - Lisa K Hornberger
- Division of Cardiology Department of Pediatrics, University of Alberta Edmonton Alberta Canada.,Department of Obstetrics & Gynecology Women & Children's Health Research Institute, University of Alberta Edmonton Alberta Canada
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21
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Moons P, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Yang HL, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Kovacs AH. Patient-reported outcomes in the aging population of adults with congenital heart disease: results from APPROACH-IS. Eur J Cardiovasc Nurs 2022; 22:339-344. [PMID: 35901014 DOI: 10.1093/eurjcn/zvac057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/21/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022]
Abstract
The congenital heart disease (CHD) population now comprises an increasing number of older persons in their 6th decade of life and beyond. We cross-sectionally evaluated patient-reported outcomes (PROs) in persons with CHD aged 60 years or older, and contrasted these with PROs of younger patients aged 40-59 years and 18-39 years. Adjusted for demographic and medical characteristics, patients ≥60 years had a lower Physical Component Summary, higher Mental Component Summary, and lower anxiety (Hospital Anxiety and Depression Scale-Anxiety) scores than patients in the two younger categories. For satisfaction with life, older persons had a higher score than patients aged 40-59 years. Registration: ClinicalTrials.gov NCT02150603.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Koen Luyckx
- School Psychology and Child and Adolescent Development, KU Leuven - University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Corina Thomet
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Education, Toyo University, Tokyo, Japan
| | - Maayke A Sluman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Hsiao Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Program, Indiana University Health, Indianapolis, IN, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, University Health Network, University of Toronto, Toronto, Canada
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Cardiac Rehabilitation, Médipôle Lyon-Villeurbanne, Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE, USA.,Taussig Heart Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adrienne H Kovacs
- Toronto Adult Congenital Heart Disease Program, University Health Network, University of Toronto, Toronto, Canada
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22
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Pillay J, Gaudet L, Wingert A, Bialy L, Mackie AS, Paterson DI, Hartling L. Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review. BMJ 2022; 378:e069445. [PMID: 35830976 PMCID: PMC9277081 DOI: 10.1136/bmj-2021-069445] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To synthesise evidence on incidence rates and risk factors for myocarditis and pericarditis after use of mRNA vaccination against covid-19, clinical presentation, short term and longer term outcomes of cases, and proposed mechanisms. DESIGN Living evidence syntheses and review. DATA SOURCES Medline, Embase, and the Cochrane Library were searched from 6 October 2020 to 10 January 2022; reference lists and grey literature (to 13 January 2021). One reviewer completed screening and another verified 50% of exclusions, using a machine learning program to prioritise records. A second reviewer verified all exclusions at full text, extracted data, and (for incidence and risk factors) risk of bias assessments using modified Joanna Briggs Institute tools. Team consensus determined certainty of evidence ratings for incidence and risk factors using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Large (>10 000 participants) or population based or multisite observational studies and surveillance data (incidence and risk factors) reporting on confirmed myocarditis or pericarditis after covid-19 mRNA vaccination; case series (n≥5, presentation, short term clinical course and longer term outcomes); opinions, letters, reviews, and primary studies focused on describing or supporting hypothesised mechanisms. RESULTS 46 studies were included (14 on incidence, seven on risk factors, 11 on characteristics and short term course, three on longer term outcomes, and 21 on mechanisms). Incidence of myocarditis after mRNA vaccines was highest in male adolescents and male young adults (age 12-17 years, range 50-139 cases per million (low certainty); 18-29 years, 28-147 per million (moderate certainty)). For girls and boys aged 5-11 years and women aged 18-29 years, incidence of myocarditis after vaccination with BNT162b2 (Pfizer/BioNTech) could be fewer than 20 cases per million (low certainty). Incidence after a third dose of an mRNA vaccine had very low certainty evidence. For individuals of 18-29 years, incidence of myocarditis is probably higher after vaccination with mRNA-1273 (Moderna) compared with Pfizer (moderate certainty). Among individuals aged 12-17, 18-29, or 18-39 years, incidence of myocarditis or pericarditis after dose two of an mRNA vaccine for covid-19 might be lower when administered ≥31 days compared with ≤30 days after dose one (low certainty). Data specific to men aged 18-29 years indicated that the dosing interval might need to increase to ≥56 days to substantially drop myocarditis or pericarditis incidence. For clinical course and short term outcomes, only one small case series (n=8) was found for 5-11 year olds. In adolescents and adults, most (>90%) myocarditis cases involved men of a median 20-30 years of age and with symptom onset two to four days after a second dose (71-100%). Most people were admitted to hospital (≥84%) for a short duration (two to four days). For pericarditis, data were limited but more variation than myocarditis has been reported in patient age, sex, onset timing, and rate of admission to hospital. Three case series with longer term (3 months; n=38) follow-up suggested persistent echocardiogram abnormalities, as well as ongoing symptoms or a need for drug treatments or restriction from activities in >50% of patients. Sixteen hypothesised mechanisms were described, with little direct supporting or refuting evidence. CONCLUSIONS These findings indicate that adolescent and young adult men are at the highest risk of myocarditis after mRNA vaccination. Use of a Pfizer vaccine over a Moderna vaccine and waiting for more than 30 days between doses might be preferred for this population. Incidence of myocarditis in children aged 5-11 years is very rare but certainty was low. Data for clinical risk factors were very limited. A clinical course of mRNA related myocarditis appeared to be benign, although longer term follow-up data were limited. Prospective studies with appropriate testing (eg, biopsy and tissue morphology) will enhance understanding of mechanism.
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Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lindsay Gaudet
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Andrew S Mackie
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Edmonton, AB, Canada
| | - D Ian Paterson
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, AB, Canada
- Cardiovascular Magnetic Resonance Imaging, Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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23
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Schraeder K, Nettel-Aguirre A, Mackie AS, McBrien K, Barrett O, Dimitropoulos G, Samuel S. Primary care service use during adolescence and young adulthood: Tertiary care cohort affected by chronic health conditions. Can Fam Physician 2022; 68:e151-e160. [PMID: 35552227 PMCID: PMC9097743 DOI: 10.46747/cfp.6805e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand use of family physician services and emergency department visits by adolescents and young adults with chronic health conditions. DESIGN Longitudinal retrospective observational cohort study using administrative health data. SETTING Chronic care clinics at a tertiary care pediatric hospital in Calgary, Alta. PARTICIPANTS In total, 1326 adolescents who were between 12 and 15 years old in 2008, who were observed until 2016, and who received medical services for chronic conditions were enrolled in the study. Eligible participants had at least 4 visits to the same chronic disease clinic in any 2-year window before age 18. MAIN OUTCOMES MEASURES Group-based trajectory modeling was used to identify groups of adolescents with distinct patterns of health care use (for visits to emergency departments and to primary care practices), while 2 tests explored trajectory group differences (eg, sex, location of residence). RESULTS Median age was 14 years (range 12 to 17 years) at study entry, and 22 years (range 14 to 24 years) at study exit. Half were female and most (85.4%) lived in an urban area. Median observation period was 8.7 person-years (range 1.3 to 9.1 years). Group-based trajectory modeling identified 5 distinct trajectory groups of primary care use and 4 groups of emergency services use. Groups differed by sex and location of residence in each trajectory model. CONCLUSION Many adolescents increased their use of emergency services between the ages of 12 and 24 years, with distinct patterns of primary care use being observed. Association of additional patient- and system-level factors (eg, disease severity, distance to nearest family physician office) should be explored.
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Affiliation(s)
- Kyleigh Schraeder
- Registered clinical psychologist in Alberta; at the time this manuscript was submitted, Dr Schraeder was a postdoctoral scholar in the Department of Pediatrics at the University of Calgary.
| | - Alberto Nettel-Aguirre
- Statistician in the Cumming School of Medicine at the University of Calgary at the time this manuscript was submitted
| | - Andrew S Mackie
- Associate Professor in the Department of Pediatrics at the University of Alberta in Edmonton
| | - Kerry McBrien
- Associate Professor in Community Health Sciences at the University of Calgary
| | - Olesya Barrett
- Senior Analyst in Clinical Analytics at Alberta Health Services in Calgary
| | - Gina Dimitropoulos
- Associate Professor in the Faculty of Social Work at the University of Calgary
| | - Susan Samuel
- Associate Professor in the Departments of Pediatrics and Community Health Sciences at the University of Calgary
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24
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Lu CW, Wang JK, Yang HL, Kovacs AH, Luyckx K, Ruperti-Repilado FJ, Van De Bruaene A, Enomoto J, Sluman MA, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Apers S, Moons P. Heart Failure and Patient-Reported Outcomes in Adults With Congenital Heart Disease from 15 Countries. J Am Heart Assoc 2022; 11:e024993. [PMID: 35470715 PMCID: PMC9238599 DOI: 10.1161/jaha.121.024993] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Heart failure (HF) is the leading cause of mortality and associated with significant morbidity in adults with congenital heart disease. We sought to assess the association between HF and patient‐report outcomes in adults with congenital heart disease. Methods and Results As part of the APPROACH‐IS (Assessment of Patterns of Patient‐Reported Outcomes in Adults with Congenital Heart disease—International Study), we collected data on HF status and patient‐reported outcomes in 3959 patients from 15 countries across 5 continents. Patient‐report outcomes were: perceived health status (12‐item Short Form Health Survey), quality of life (Linear Analogue Scale and Satisfaction with Life Scale), sense of coherence‐13, psychological distress (Hospital Anxiety and Depression Scale), and illness perception (Brief Illness Perception Questionnaire). In this sample, 137 (3.5%) had HF at the time of investigation, 298 (7.5%) had a history of HF, and 3524 (89.0%) had no current or past episode of HF. Patients with current or past HF were older and had a higher prevalence of complex congenital heart disease, arrhythmias, implantable cardioverter‐defibrillators, other clinical comorbidities, and mood disorders than those who never had HF. Patients with HF had worse physical functioning, mental functioning, quality of life, satisfaction with life, sense of coherence, depressive symptoms, and illness perception scores. Magnitudes of differences were large for physical functioning and illness perception and moderate for mental functioning, quality of life, and depressive symptoms. Conclusions HF in adults with congenital heart disease is associated with poorer patient‐reported outcomes, with large effect sizes for physical functioning and illness perception. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT02150603.
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Affiliation(s)
- Chun-Wei Lu
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
| | - Hsiao-Ling Yang
- School of Nursing College of Medicine National Taiwan University Taipei Taiwan.,Department of Nursing National Taiwan University Hospital Taipei Taiwan
| | - Adrienne H Kovacs
- Toronto Adult Congenital Heart Disease ProgramPeter Munk Cardiac CenterUniversity Health NetworkUniversity of Toronto Toronto Canada.,Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context KU Leuven Leuven Belgium.,UNIBSUniversity of the Free State Bloemfontein South Africa
| | - Francisco Javier Ruperti-Repilado
- Center for Congenital Heart Disease Department of Cardiology Inselspital - Bern University HospitalUniversity of Bern Bern Switzerland
| | - Alexander Van De Bruaene
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium.,KU Leuven Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | | | - Maayke A Sluman
- Coronel Institute of Occupational HealthAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands.,Department of Cardiology Jeroen Bosch Hospital's Hertogenbosch The Netherlands
| | - Jamie L Jackson
- Center for Biobehavioral Health Nationwide Children's Hospital Columbus OH
| | - Paul Khairy
- Adult Congenital Heart CenterMontreal Heart InstituteUniversité de Montréal Montreal Canada
| | - Stephen C Cook
- Indiana University Health Adult Congenital Heart Disease Program Indianapolis IN
| | - Shanthi Chidambarathanu
- Pediatric Cardiology Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation) Chennai India
| | - Luis Alday
- Division of Cardiology Hospital de Niños Córdoba Argentina
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease ProgramPeter Munk Cardiac CenterUniversity Health NetworkUniversity of Toronto Toronto Canada
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center Oslo University Hospital - Rikshospitalet Oslo Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit Sahlgrenska University Hospital/Östra Gothenburg Sweden.,Institute of Medicine The Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden.,Centre for Person-Centred Care (GPCC) University of Gothenburg Gothenburg Sweden
| | - Malin Berghammer
- Department of Health Sciences University West Trollhättan Sweden.,Department of Paediatrics Queen Silvia Children's HospitalSahlgrenska University Hospital Gothenburg Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Andrew S Mackie
- Division of Cardiology Stollery Children's HospitalUniversity of Alberta Edmonton Canada
| | - Samuel Menahem
- Monash HeartMonash Medical CentreMonash University Melbourne Australia
| | - Maryanne Caruana
- Department of Cardiology Mater Dei Hospital Birkirkara Bypass Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease CenterCincinnati Children's Hospital Medical Center Cincinnati OH
| | - Alexandra Soufi
- Department of Cardiac Rehabilitation Médipôle Lyon-Villeurbanne Lyon France
| | - Susan M Fernandes
- Adult Congenital Heart Program at StanfordLucile Packard Children's Hospital and Stanford Health Care Palo Alto CA
| | - Kamila White
- Adult Congenital Heart Disease CenterWashington University and Barnes Jewish Heart & Vascular CenterUniversity of Missouri Saint Louis MO
| | - Edward Callus
- Clinical Psychology Service IRCCS Policlinico San Donato Milan Italy.,Department of Biomedical Sciences for Health University of Milan Milan Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of NebraskaMedical Center/Children's Hospital and Medical Center Omaha NE.,Taussig Heart CenterJohns Hopkins School of Medicine Baltimore MD
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care KU Leuven Leuven Belgium
| | - Philip Moons
- Centre for Person-Centred Care (GPCC) University of Gothenburg Gothenburg Sweden.,KU Leuven Department of Public Health and Primary Care KU Leuven Leuven Belgium.,Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden.,Department of Paediatrics and Child Health University of Cape Town Cape Town South Africa
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John AS, Jackson JL, Moons P, Uzark K, Mackie AS, Timmins S, Lopez KN, Kovacs AH, Gurvitz M. Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025278. [PMID: 35297271 PMCID: PMC9075425 DOI: 10.1161/jaha.122.025278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.
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Mackie AS, Veldtman GR, Thorup L, Hjortdal VE, Dori Y. Plastic Bronchitis and Protein-Losing Enteropathy in the Fontan Patient: Evolving Understanding and Emerging Therapies. Can J Cardiol 2022; 38:988-1001. [DOI: 10.1016/j.cjca.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 12/17/2022] Open
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Olugbuyi O, Smith C, Islam S, Eckserley L, Douglas D, Mackie AS, Kaul P, Hornberger LK. REMOTENESS OF RESIDENCE FROM A SURGICAL PROGRAM BUT NOT SOCIOECONOMIC STATUS IS ASSOCIATED WITH HIGHER IN-HOSPITAL MORTALITY IN INFANTS WITH MAJOR CONGENITAL HEART DISEASE IN A JURISDICTION OF UNIVERSAL HEALTH CARE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mackie AS, Rankin KN, Yaskina M, Gingrich J, Williams E, Schuh M, Kovacs AH, McCrindle BW, Nicholas D, Rempel GR. Transition Preparation for Young Adolescents with Congenital Heart Disease: A Clinical Trial. J Pediatr 2022; 241:36-41.e2. [PMID: 34619115 DOI: 10.1016/j.jpeds.2021.09.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of a novel nurse-led transition intervention program designed for young adolescents (age 13-14 years) with congenital heart disease (CHD). We hypothesized that the intervention would result in improved self-management skills and CHD knowledge. STUDY DESIGN Single-center cluster randomized controlled trial of a nurse-led transition intervention vs usual care. The intervention group received a 1-hour individualized session with a cardiology nurse, focusing on CHD education and self-management. The primary end point was change in TRANSITION-Q (transition readiness) score between baseline and 6 months. The secondary end point was change in MyHeart score (CHD knowledge). RESULTS We randomized 60 participants to intervention (n = 30) or usual care (n = 30). TRANSITION-Q score (range 0-100) increased from 49 ± 10 at baseline to 54 ± 9.0 at 6 months (intervention) vs 47 ± 14 to 44 ± 14 (usual care). Adjusted for baseline score, TRANSITION-Q scores at 1 and 6 months were greater in the intervention group (mean difference 5.9, 95% CI 1.3-10.5, P = .01). MyHeart score (range 0-100) increased from 48 ± 24 at baseline to 71 ± 16 at 6 months (intervention) vs 54 ± 24 to 57 ± 22 (usual care). Adjusted for baseline score, MyHeart scores at 1 and 6 months were greater in the intervention group (mean difference 19, 95% CI 12-26, P < .0001). Participants aged 14 years had a greater increase in TRANSITION-Q score at 6 months compared with 13-year-old participants (P < .05). CONCLUSIONS A nurse-led program improved transition readiness and CHD knowledge among young adolescents. This simple intervention can be readily adopted in other healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02374892.
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Affiliation(s)
- Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
| | - Kathryn N Rankin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jody Gingrich
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | | | | | - Brian W McCrindle
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Gwen R Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
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Selamet Tierney ES, Runeckles K, Tremoulet AH, Dahdah N, Portman MA, Mackie AS, Harahsheh AS, Lang SM, Choueiter NF, Li JS, Manlhiot C, Low T, Mathew M, Friedman KG, Raghuveer G, Norozi K, Szmuszkovicz JR, McCrindle BW. Variation in Pharmacologic Management of Patients with Kawasaki Disease with Coronary Artery Aneurysms. J Pediatr 2022; 240:164-170.e1. [PMID: 34474088 DOI: 10.1016/j.jpeds.2021.08.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/23/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate practice variation in pharmacologic management in the International Kawasaki Disease Registry (IKDR). STUDY DESIGN Practice variation in intravenous immunoglobulin (IVIG) therapy, anti-inflammatory agents, statins, beta-blockers, antiplatelet therapy, and anticoagulation was described. RESULTS We included 1627 patients from 30 IKDR centers with maximum coronary artery aneurysm (CAA) z scores 2.5-4.99 in 848, 5.0-9.99 in 349, and ≥10.0 (large/giant) in 430 patients. All centers reported IVIG and acetylsalicylic acid (ASA) as primary therapy and use of additional IVIG or steroids as needed. In 23 out of 30 centers, (77%) infliximab was also used; 11 of these 23 centers reported using it in <10% of their patients, and 3 centers used it in >20% of patients. Nonsteroidal anti-inflammatory agents were used in >10% of patients in only nine centers. Beta-blocker (8.8%, all patients) and abciximab (3.6%, all patients) were mainly prescribed in patients with large/giant CAAs. Statins (2.7%, all patients) were mostly used in one center and only in patients with large/giant CAAs. ASA was the primary antiplatelet modality for 99% of patients, used in all centers. Clopidogrel (18%, all patients) was used in 24 centers, 11 of which used it in >50% of their patients with large/giant CAAs. CONCLUSIONS In the IKDR, IVIG and ASA therapy as primary therapy is universal with common use of a second dose of IVIG for persistent fever. There is practice variation among centers for adjunctive therapies and anticoagulation strategies, likely reflecting ongoing knowledge gaps. Randomized controlled trials nested in a high-quality collaborative registry may be an efficient strategy to reduce practice variation.
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Affiliation(s)
- Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, School of Medicine, Palo Alto, CA.
| | - Kyle Runeckles
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital-San Diego, San Diego, CA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Ashraf S Harahsheh
- Pediatrics-Cardiology, Children's National Hospital/George Washington University School of Medicine, Washington, DC
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Cedric Manlhiot
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tisiana Low
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mathew Mathew
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Kambiz Norozi
- Department of Pediatrics, Western University, London, Canada
| | | | - Brian W McCrindle
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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Leibold A, Eichler E, Chung S, Moons P, Kovacs AH, Luyckx K, Apers S, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, White K, Callus E, Kutty S, Fernandes SM. Pain in adults with congenital heart disease - An international perspective. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Charles S, Mackie AS, Rogers LG, McCrindle BW, Kovacs AH, Yaskina M, Williams E, Dragieva D, Mustafa S, Schuh M, Anthony SJ, Rempel GR. A Typology of Transition Readiness for Adolescents with Congenital Heart Disease in Preparation for Transfer from Pediatric to Adult Care. J Pediatr Nurs 2021; 60:267-274. [PMID: 34352719 DOI: 10.1016/j.pedn.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To understand the effectiveness of a nurse-led transition intervention by analyzing qualitative data generated in the context of a clinical trial. DESIGN & METHODS Qualitative study of a two-session transition intervention conducted by registered nurses at two sites. Adolescents aged 16-17 years with moderate or complex congenital heart disease (CHD) had been randomized to a two-session transition intervention or usual care. Session 1 emphasized patient education including creation of a health passport and goal setting. Session 2, two months later, emphasized self-management. Qualitative data extracted from intervention logs, field notes and audio recordings of the sessions were analyzed for content and themes. RESULTS Data from 111 transition intervention sessions with 57 adolescents were analyzed. Creating a health passport, goal setting, and role-plays were the elements of the intervention most valued by participants. A typology of transition readiness was identified: 1) the independent adolescent (5%), already managing their own care; 2) the ready adolescent who was prepared for transition after completing the intervention (46%); 3) the follow-up needed adolescent who was still in need of extra coaching (26%), and 4) the at-risk adolescent who warranted immediate follow-up (14%). Baseline knowledge and transition surveys scores validated the typology. CONCLUSIONS A two-session nursing intervention met the transition needs of approximately half of adolescents with CHD. However, additional transition-focused care was needed by 40% of participants (groups 3 and 4). PRACTICE IMPLICATIONS These findings will guide pediatric nurses and other healthcare professionals to optimize an individualized approach for ensuring transition readiness for adolescents with CHD.
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Affiliation(s)
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, AB, Canada; Stollery Children's Hospital, AB, Canada.
| | - Laura G Rogers
- Faculty of Nursing, University of Alberta, AB, Canada; Faculty of Health Disciplines, Athabasca University, AB, Canada.
| | - Brian W McCrindle
- Paediatrics, University of Toronto, ON, Canada; The Hospital for Sick Children (SickKids), ON, Canada.
| | | | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Canada.
| | - Elina Williams
- Stollery Children's Hospital, AB, Canada; Western Canadian Children's Heart Network, Canada.
| | - Dimi Dragieva
- The Hospital for Sick Children (SickKids), ON, Canada.
| | | | | | - Samantha J Anthony
- The Hospital for Sick Children (SickKids), ON, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada.
| | - Gwen R Rempel
- Faculty of Nursing, University of Alberta, AB, Canada; Faculty of Health Disciplines, Athabasca University, AB, Canada.
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Plante V, Gobeil L, Xiong WT, Touré M, Dahdah N, Greenway SC, Drolet C, Wong KK, Mackie AS, Bradley TJ, Mertens L, Cavallé-Garrido T, Penslar J, Wong D, Dallaire F. Alternative to body surface area as a solution to correct systematic bias in pediatric echocardiography Z scores. Can J Cardiol 2021; 37:1790-1797. [PMID: 34216742 DOI: 10.1016/j.cjca.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Z scores are the method of choice to report dimensions in pediatric echocardiography. Z scores based on body surface area (BSA) have been shown to cause systematic biases in overweight and obese children. Using aortic valve (AoV) diameters as a paradigm, the aims of this study were to assess the magnitude of Z score underestimation in children with increased body mass index Z score (BMI-Z) and to determine if a predicting model with height and weight as independent predictors would minimize this bias. METHODS In this multicenter, retrospective, cross-sectional study, 15,006 normal echocardiograms in healthy children 1-18 years old were analyzed. Residual associations with body size were assessed for previously published Z score. BSA-based and alternative prediction models based on height and weight were developed and validated in separate training and validation samples. RESULTS Existing BSA-based Z scores incompletely adjusted for weight, BSA and BMI-Z and led to an underestimation of >0.8 Z score units in subjects with higher BMI-Z, compared to lean subjects. BSA-based models led to overestimation of predicted AoV diameters with increasing weight or BMI-Z. Models using height and weight as independent predictors improved adjustment with body size, including in children with higher BMI-Z. CONCLUSIONS BSA-based models result in underestimation of Z scores in patients with high BMI-Z. Prediction models using height and weight as independent predictors minimize residual associations with body size and generate well-fitted predicted values that could apply to all children, including those with low or high BMI-Z.
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Affiliation(s)
- Virginie Plante
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Laurence Gobeil
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Wei Ting Xiong
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moustapha Touré
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte-Justine University Hospital, Université de Montréal, Montreal, QC, Canada
| | - Steven C Greenway
- Departments of Pediatrics, Cardiac Sciences and Biochemistry & Molecular Biology, Alberta Children's Hospital Research Institute and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christian Drolet
- Centre Hospitalier de l'Université Laval, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Kenny K Wong
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Timothy J Bradley
- Division of Cardiology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Luc Mertens
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tiscar Cavallé-Garrido
- Division of Cardiology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Joshua Penslar
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Derek Wong
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Frédéric Dallaire
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada.
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Harris KC, Mackie AS, Dallaire F, Khoury M, Singer J, Mahle WT, Klassen TP, McCrindle BW. Unique Challenges of Randomised Controlled Trials in Pediatric Cardiology. Can J Cardiol 2021; 37:1394-1403. [PMID: 34186112 DOI: 10.1016/j.cjca.2021.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 02/07/2023] Open
Abstract
Pediatric cardiology has evolved over time with reductions in childhood mortality due to congenital heart disease. Surgical innovation drove early changes in care. Increasingly, the need for more robust evidence provided by randomised controlled trials (RCTs) has been recognised. Although the number of RCTs has increased, there remains a relative paucity of truly impactful trials in the field. However, those trials that have changed practice have demonstrated the potential and importance of this work. Examples include the PRIMACORP trial, which established the safety and efficacy of milrinone after cardiac surgery, and the Single Ventricle Reconstruction trial, which was the first multicentre pediatric cardiac surgical RCT. The successful conduct and important findings emanating from these trials serve as beacons as clinicians strive to improve the evidence base in this field. The establishment of national and international networks such as the Pediatric Heart Network and the Canadian Pediatric Cardiology Research Network provide a strong foundation for future collaborative work. Despite this progress, there remain important challenges to designing and executing RCTs in pediatric cardiology. These include issues of greater disease and patient heterogeneity and increased costs. The use of innovative study designs and analytic methods and the establishment of core outcome measures have the potential to overcome some of the issues related to the smaller patient numbers compared with adult disciplines. As pediatric cardiologists look to the future, it is imperative that we work together to derive the maximum benefit from the considerable efforts directed toward conducting impactful clinical trials in pediatric cardiology.
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Affiliation(s)
- Kevin C Harris
- Children's Heart Centre, British Columbia Children's Hospital &-University of British Columbia, Vancouver, British Columbia, Canada.
| | - Andrew S Mackie
- Division of Pediatric Cardiology, Department of Pediatrics Stollery Children's Hospital. University of Alberta, Edmonton, Alberta, Canada
| | - Frederic Dallaire
- Division of Pediatric Cardiology, Department of Pediatrics, Sherbrooke University, Sherbrooke, Québec, Canada
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics Stollery Children's Hospital. University of Alberta, Edmonton, Alberta, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - William T Mahle
- Division of Pediatric Cardiology, Emory University, Atlanta, Georgia, USA
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba and Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Dallaire F, Battista MC, Greenway SC, Harris K, Jean-St-Michel E, Mackie AS. The Canadian Pediatric Cardiology Research Network: A Model National Data-Sharing Organization to Facilitate the Study of Pediatric Heart Diseases. CJC Open 2021; 3:510-515. [PMID: 34027355 PMCID: PMC8129477 DOI: 10.1016/j.cjco.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Common hurdles to pediatric cardiology research include the heterogeneity and relative rarity of specific cardiac malformations, the potential for effect of residual lesions occurring decades after repair, and the scarcity of objective and easily measurable outcomes such as death and transplantation. METHODS To help meet these challenges, the Canadian Pediatric Cardiology Research Network (CPCRN) was founded by the Canadian Pediatric Cardiology Association to link Canadian academic institutions to promote and facilitate multicollaborations for the benefit of pediatric and congenital cardiology research. The overarching goal of the CPCRN is to build a national framework that harnesses the strong desire for collaboration within the pediatric cardiology community and to identify solutions to barriers that impede multicentre partnerships. RESULTS In this report, the authors describe the approach and the components of the CPCRN. Specifically, we detail the rolling out of a pan-Canadian master agreement that covers current and future studies, the systematic banking of all project data, and the mechanisms developed to facilitate secondary use of data. CONCLUSIONS This experience could help guide the formation of other national research groups, particularly those focused on congenital or rare diseases.
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Affiliation(s)
- Frédéric Dallaire
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, and Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Claude Battista
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Steven C Greenway
- Departments of Pediatrics, Cardiac Sciences and Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Harris
- BC Children's Hospital, Vancouver, British Columbia, Canada
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Osborne J, Friedman K, Runeckles K, Choueiter NF, Giglia TM, Dallaire F, Newburger JW, Low T, Mathew M, Mackie AS, Dahdah N, Yetman AT, Harahsheh AS, Raghuveer G, Norozi K, Burns JC, Jain S, Mondal T, Portman MA, Szmuszkovicz JR, Crean A, McCrindle BW. Comparison Between Currently Recommended Long-Term Medical Management of Coronary Artery Aneurysms After Kawasaki Disease and Actual Reported Management in the Last Two Decades. Pediatr Cardiol 2021; 42:676-684. [PMID: 33439285 DOI: 10.1007/s00246-020-02529-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Abstract
In the 2017 American Heart Association (AHA) Kawasaki disease (KD) guidelines, risk levels (RLs) for long-term management are defined by both maximal and current coronary artery (CA) dimensions normalized as z-scores. We sought to determine the degree to which current recommended practice differs from past actual practice, highlighting areas for knowledge translation efforts. The International KD Registry (IKDR) included 1651 patients with CA aneurysms (z-score > 2.5) from 1999 to 2016. Patients were classified by AHA RL using maximum CA z-score (RL 3 = small, RL 4 = medium, RL 5 = large/giant) and subcategorized based on decreases over time. Medical management provided was compared to recommendations. Low-dose acetylsalicylic acid (ASA) use ranged from 86 (RL 3.1) to 95% (RL 5.1) for RLs where use was "indicated." Dual antiplatelet therapy (ASA + clopidogrel) use ranged from 16% for RL 5.2 to 9% for RL 5.4. Recommended anticoagulation (warfarin or low molecular weight heparin) use was 65% for RL 5.1, while 12% were on triple therapy (anticoagulation + dual antiplatelet). Optional statin use ranged from 2 to 8% depending on RL. Optional beta-blocker use was 2-25% for RL 5, and 0-5% for RLs 3 and 4 where it is not recommended. Generally, past practice was consistent with the latest AHA guidelines, taking into account the flexible wording of recommendations based on the limited evidence, as well as unmeasured patient-specific factors. In addition to strengthening the overall evidence base, knowledge translation efforts may be needed to address variation in thromboprophylaxis management.
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Affiliation(s)
- Jonathon Osborne
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Kevin Friedman
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyle Runeckles
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Frederic Dallaire
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jane W Newburger
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tisiana Low
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mathew Mathew
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Anji T Yetman
- Children's Hospital & Medical Center of Omaha, Omaha, NE, USA
| | - Ashraf S Harahsheh
- Pediatrics - Cardiology, Children's National Hospital/George Washington University School of Medicine, Washington, DC, USA
| | | | - Kambiz Norozi
- Department of Paediatrics, Western University, London, ON, Canada
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Supriya Jain
- Maria Fareri Children's Hospital at Westchester Medical Center (WMC) Health, New York Medical College, Valhalla, NY, USA
| | - Tapas Mondal
- McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | | | - Brian W McCrindle
- Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Moons P, Apers S, Kovacs AH, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Luyckx K. Sense of coherence in adults with congenital heart disease in 15 countries: Patient characteristics, cultural dimensions and quality of life. Eur J Cardiovasc Nurs 2021; 20:48-55. [PMID: 32524857 DOI: 10.1177/1474515120930496] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have found that sense of coherence (SOC) is positively related to quality of life (QoL) in persons with chronic conditions. In congenital heart disease (CHD), the evidence is scant. AIMS We investigated (i) intercountry variation in SOC in a large international sample of adults with CHD; (ii) the relationship between demographic and clinical characteristics and SOC; (iii) the relationship between cultural dimensions of countries and SOC; and (iv) variation in relative importance of SOC in explaining QoL across the countries. METHODS APPROACH-IS was a cross-sectional, observational study, with 4028 patients from 15 countries enrolled. SOC was measured using the 13-item SOC scale (range 13-91) and QoL was assessed by a linear analog scale (range 0-100). RESULTS The mean SOC score was 65.5±13.2. Large intercountry variation was observed with the strongest SOC in Switzerland (68.8±11.1) and the lowest SOC in Japan (59.9±14.5). A lower SOC was associated with a younger age; lower educational level; with job seeking, being unemployed or disabled; unmarried, divorced or widowed; from a worse functional class; and simple CHD. Power distance index and individualism vs collectivism were cultural dimensions significantly related to SOC. SOC was positively associated with QoL in all participating countries and in the total sample, with an explained variance ranging from 5.8% in Argentina to 30.4% in Japan. CONCLUSION In adults with CHD, SOC is positively associated with QoL. The implementation of SOC-enhancing interventions might improve QoL, but strategies would likely differ across countries given the substantial variation in explained variance.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Adrienne H Kovacs
- Toronto Congenital Cardiac Center for Adults, University Health Network, University of Toronto, Canada
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
| | - Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital - Bern University Hospital, University of Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- KU Leuven Department of Cardiovascular Sciences, KU Leuven, Belgium
| | | | - Maayke A Sluman
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, the Netherlands
- Department of Cardiology, Jeroen Bosch Hospital, the Netherlands
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Argentina
| | - Erwin Oechslin
- Toronto Congenital Cardiac Center for Adults, University Health Network, University of Toronto, Canada
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sweden
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Department of Health Sciences, University West, Sweden
- Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Australia
| | | | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/Children's Hospital and Medical Center, USA
- Taussig Heart Center, Johns Hopkins School of Medicine, USA
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven, Belgium
- UNIBS, University of the Free State, South Africa
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Callus E, Pagliuca S, Boveri S, Ambrogi F, Luyckx K, Kovacs AH, Apers S, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Kutty S, Moons P. Phenotypes of adults with congenital heart disease around the globe: a cluster analysis. Health Qual Life Outcomes 2021; 19:53. [PMID: 33568120 PMCID: PMC7877115 DOI: 10.1186/s12955-021-01696-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To derive cluster analysis-based groupings for adults with congenital heart disease (ACHD) when it comes to perceived health, psychological functioning, health behaviours and quality of life (QoL). METHODS This study was part of a larger worldwide multicentre study called APPROACH-IS; a cross sectional study which recruited 4028 patients (2013-2015) from 15 participating countries. A hierarchical cluster analysis was performed using Ward's method in order to group patients with similar psychological characteristics, which were defined by taking into consideration the scores of the following tests: Sense Of Coherence, Health Behavior Scale (physical exercise score), Hospital Anxiety Depression Scale, Illness Perception Questionnaire, Satisfaction with Life Scale and the Visual Analogue Scale scores of the EQ-5D perceived health scale and a linear analogue scale (0-100) measuring QoL. RESULTS 3768 patients with complete data were divided into 3 clusters. The first and second clusters represented 89.6% of patients in the analysis who reported a good health perception, QoL, psychological functioning and the greatest amount of exercise. Patients in the third cluster reported substantially lower scores in all PROs. This cluster was characterised by a significantly higher proportion of females, a higher average age the lowest education level, more complex forms of congenital heart disease and more medical comorbidities. CONCLUSIONS This study suggests that certain demographic and clinical characteristics may be linked to less favourable health perception, quality of life, psychological functioning, and health behaviours in ACHD. This information may be used to improve psychosocial screening and the timely provision of psychosocial care.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Silvana Pagliuca
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Adrienne H Kovacs
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada.,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Education, Toyo University, Tokyo, Japan
| | - Maayke A Sluman
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Adult Congenital HeartProgram at Stanford, Lucile Packard Children's Hospital Stanford and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA.,Taussig Heart Center, Johns Hopkins School of Medicine, Baltimore, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden. .,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Casteigt B, Samuel M, Laplante L, Shohoudi A, Apers S, Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Brouillette J, Moons P, Khairy P. Atrial arrhythmias and patient-reported outcomes in adults with congenital heart disease: An international study. Heart Rhythm 2020; 18:793-800. [PMID: 32961334 DOI: 10.1016/j.hrthm.2020.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD. OBJECTIVE The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations. METHODS Associations between atrial arrhythmias and PROs were assessed in a cross-sectional study of adults with CHD from 15 countries spanning 5 continents. A propensity-based matching weight analysis was performed to compare quality of life, perceived health status, psychological distress, sense of coherence, and illness perception in patients with and those without atrial arrhythmias. RESULTS A total of 4028 adults with CHD were enrolled, 707 (17.6%) of whom had atrial arrhythmias. After applying matching weights, patients with and those without atrial arrhythmias were comparable with regard to age (mean 40.1 vs 40.2 years), demographic variables (52.5% vs 52.2% women), and complexity of CHD (15.9% simple, 44.8% moderate, and 39.2% complex in both groups). Patients with atrial arrhythmias had significantly worse PRO scores with respect to quality of life, perceived health status, psychological distress (ie, depression), and illness perception. A summary score that combines all PRO measures was significantly lower in patients with atrial arrhythmias (-3.3%; P = .0006). Differences in PROs were consistent across geographic regions. CONCLUSION Atrial arrhythmias in adults with CHD are associated with an adverse impact on a broad range of PROs consistently across various geographic regions.
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Affiliation(s)
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Azadeh Shohoudi
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Koen Luyckx
- KU Leuven-University of Leuven, Psychology and Development in Context, Leuven, Belgium and UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands and Coronel Institute for Occupational Health, Academic Medical Centre, Amsterdam, the Netherlands
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | | | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Department of Cardiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg and Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Lyon, France
| | - Susan M Fernandes
- Department of Pediatrics and Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, and University of Missouri, Saint Louis, Missouri
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, Omaha, Nebraska
| | | | - Philip Moons
- KU Leuven-University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden, and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada.
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McCrindle BW, Manlhiot C, Newburger JW, Harahsheh AS, Giglia TM, Dallaire F, Friedman K, Low T, Runeckles K, Mathew M, Mackie AS, Choueiter NF, Jone PN, Kutty S, Yetman AT, Raghuveer G, Pahl E, Norozi K, McHugh KE, Li JS, De Ferranti SD, Dahdah N. Medium-Term Complications Associated With Coronary Artery Aneurysms After Kawasaki Disease: A Study From the International Kawasaki Disease Registry. J Am Heart Assoc 2020; 9:e016440. [PMID: 32750313 PMCID: PMC7792232 DOI: 10.1161/jaha.119.016440] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Coronary artery aneurysms (CAAs) may occur after Kawasaki disease (KD) and lead to important morbidity and mortality. As CAA in patients with KD are rare and heterogeneous lesions, prognostication and risk stratification are difficult. We sought to derive the cumulative risk and associated factors for cardiovascular complications in patients with CAAs after KD. Methods and Results A 34‐institution international registry of 1651 patients with KD who had CAAs (maximum CAA Z score ≥2.5) was used. Time‐to‐event analyses were performed using the Kaplan–Meier method and Cox proportional hazard models for risk factor analysis. In patients with CAA Z scores ≥10, the cumulative incidence of luminal narrowing (>50% of lumen diameter), coronary artery thrombosis, and composite major adverse cardiovascular complications at 10 years was 20±3%, 18±2%, and 14±2%, respectively. No complications were observed in patients with a CAA Z score <10. Higher CAA Z score and a greater number of coronary artery branches affected were associated with increased risk of all types of complications. At 10 years, normalization of luminal diameter was noted in 99±4% of patients with small (2.5≤Z<5.0), 92±1% with medium (5.0≤Z<10), and 57±3% with large CAAs (Z≥10). CAAs in the left anterior descending and circumflex coronary artery branches were more likely to normalize. Risk factor analysis of coronary artery branch level outcomes was performed with a total of 893 affected branches with Z score ≥10 in 440 patients. In multivariable regression models, hazards of luminal narrowing and thrombosis were higher for patients with CAAs of the right coronary artery and left anterior descending branches, those with CAAs that had complex architecture (other than isolated aneurysms), and those with CAAs with Z scores ≥20. Conclusions For patients with CAA after KD, medium‐term risk of complications is confined to those with maximum CAA Z scores ≥10. Further risk stratification and close follow‐up, including advanced imaging, in patients with large CAAs is warranted.
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Affiliation(s)
- Brian W McCrindle
- Division of Cardiology Department of Pediatrics University of Toronto The Hospital for Sick Children Toronto Ontario Canada
| | - Cedric Manlhiot
- Division of Cardiology Department of Pediatrics University of Toronto The Hospital for Sick Children Toronto Ontario Canada
| | | | - Ashraf S Harahsheh
- Pediatrics - Cardiology Children's National Health System/George Washington University Washington DC
| | | | - Frederic Dallaire
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke Sherbrooke Quebec Canada
| | - Kevin Friedman
- Boston Children's Hospital Harvard Medical School Boston MA
| | - Tisiana Low
- Division of Cardiology Department of Pediatrics University of Toronto The Hospital for Sick Children Toronto Ontario Canada
| | - Kyle Runeckles
- Division of Cardiology Department of Pediatrics University of Toronto The Hospital for Sick Children Toronto Ontario Canada
| | - Mathew Mathew
- Division of Cardiology Department of Pediatrics University of Toronto The Hospital for Sick Children Toronto Ontario Canada
| | | | | | - Pei-Ni Jone
- Pediatric Cardiology Children's Hospital Colorado University of Colorado School of Medicine Aurora CO
| | - Shelby Kutty
- Children's Hospital & Medical Center of Omaha NE
| | | | | | - Elfriede Pahl
- Ann and Robert H. Lurie Children's Hospital of Chicago IL
| | - Kambiz Norozi
- Department of Paediatrics Western University London Ontario Canada
| | | | | | | | - Nagib Dahdah
- Division of Pediatric Cardiology Centre Hospitalier Universitaire Ste-Justine University of Montreal Quebec Canada
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40
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Chung RJ, Mackie AS, Baker A, de Ferranti SD. Cardiovascular Risk and Cardiovascular Health Behaviours in the Transition From Childhood to Adulthood. Can J Cardiol 2020; 36:1448-1457. [PMID: 32585325 DOI: 10.1016/j.cjca.2020.05.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 01/17/2023] Open
Abstract
The prevention and management of cardiovascular risk factors during the transition from childhood to adulthood is critically important in defining cardiovascular health trajectories. Unfortunately, many young people fall out of clinical care during this important time, leading to worsening cardiovascular risk and missed opportunities to modify future outcomes. The field of health care transition has evolved to support young people with complex health needs in developing self-management and self-advocacy skills to promote positive health outcomes despite changes in health care providers and resources. While transitional care efforts are largely focused on childhood-onset chronic illnesses such as sickle cell disease and cystic fibrosis, young people with cardiovascular risk factors such as hypertension, obesity, and dyslipidemia also stand to benefit from structured supports to ensure continuity in care and positive health behaviours. On the backdrop of the broader health care transition literature, we offer practical insights and suggestions for ensuring that young people with cardiovascular risk factors experience uninterrupted high-quality care and support as they enter the adult health care system. Starting transition preparation in early adolescence, actively engaging all key stakeholders throughout the process, and remaining mindful of the developmental underpinnings and social context of transition are keys to success.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Annette Baker
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Khoury M, Rodday AM, Mackie AS, Gill P, McLaughlin T, Harris KC, Wong P, McCrindle BW, Birken CS, de Ferranti SD. Pediatric Lipid Screening and Treatment in Canada: Practices, Attitudes, and Barriers. Can J Cardiol 2020; 36:1545-1549. [PMID: 32502521 DOI: 10.1016/j.cjca.2020.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022] Open
Abstract
The pediatric lipid screening and treatment practices, attitudes, and perceived barriers of Canadian pediatricians are not known. We sought to evaluate this in a survey of pediatricians through the Canadian Pediatric Surveillance Program (CPSP) in March 2019. The survey included an assessment of lipid screening of 9- to 11-year-old youth and a hypothetical case of persistent severe dyslipidemia to ascertain management practices. There were 759 respondents (28% response rate, 759 of 2742), of whom 236 provided outpatient primary care to 9- to 11-year-old youth as part of their routine clinical practice. Among primary care-providing pediatricians, universal lipid screening of healthy 9- to 11-year-old youth most or all of the time was reported by 3% (8 of 230). Reported screening practices most or all of the time were more common for youth with risk factors such as overweight and obesity (54%, 127 of 235) and a family history of premature cardiovascular disease (39%, 85 of 217). Most respondents would refer a child with severe persistent dyslipidemia to dieticians (69%, 152 of 220) and a lipid specialist (64%, 144 of 220) most or all of the time, whereas 7% (16 of 220) would start statin therapy themselves. A lack of Canadian pediatric lipid guidelines was reported as a major barrier for 49% (114 of 233) and minor barrier for 40% (93 of 213). The rate of routine lipid screening of healthy 9- to 11-year-old youth among Canadian primary care-providing pediatricians is low and at odds with current US guidelines. This discrepancy may be due at least in part to a lack of Canadian guidelines on pediatric dyslipidemia, the development of which may address certain perceived barriers and influence future attitudes.
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Affiliation(s)
- Michael Khoury
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Gill
- Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children. University of Toronto, Ontario, Canada
| | - Tom McLaughlin
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Wong
- Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children. University of Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Center, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children. University of Toronto, Ontario, Canada
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Van Bulck L, Goossens E, Luyckx K, Apers S, Oechslin E, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries. BMC Health Serv Res 2020; 20:496. [PMID: 32493367 PMCID: PMC7268498 DOI: 10.1186/s12913-020-05361-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease. METHODS This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed. CONCLUSIONS This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn. TRIAL REGISTRATION ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
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Affiliation(s)
- Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Silke Apers
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Chun-Wei Lu
- National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Msida, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium. .,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Lévesque V, Laplante L, Shohoudi A, Apers S, Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Brouillette J, Casteigt B, Moons P, Khairy P. Implantable cardioverter-defibrillators and patient-reported outcomes in adults with congenital heart disease: An international study. Heart Rhythm 2020; 17:768-776. [DOI: 10.1016/j.hrthm.2019.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/21/2022]
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Lemire O, Yaraskavitch J, Lougheed J, Mackie AS, Norozi K, Graham J, Willan AR, Longmuir PE. Impacting child health outcomes in congenital heart disease: Cluster randomized controlled trial protocol of in-clinic physical activity counselling. Contemp Clin Trials 2020; 91:105994. [PMID: 32222326 DOI: 10.1016/j.cct.2020.105994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most (>90%) children with congenital health defects are not active enough for optimal health. Proactively promoting physical activity during every clinic visit is recommended, but rarely implemented due to a lack of appropriate resources. METHODS This cluster randomized controlled trial will implement an evidence-based, multi-faceted physical activity intervention. All eligible patients at small (London, ON), medium (Ottawa, ON) and large (Edmonton, AB) pediatric cardiac clinics will be approached, with randomization to intervention/control by clinic and week. Intervention patients will be counselled with 5 key physical activity messages, have questions about physical activity answered, and have access to a custom web site with personalized activity suggestions and support from a Registered Kinesiologist. The primary outcome is daily physical activity (number of steps, minutes of moderate-to-vigorous activity) assessed via pedometer one week per month for 6-months. Standardized questionnaires assess activity motivation and quality of life at baseline and end of study. Healthcare outcomes will be clinic visit time and contacts for physical activity concerns. Repeated measures ANCOVA will compare control/intervention pedometer outcomes, adjusting for covariates (alpha=0.05). CONCLUSIONS This trial aims to determine whether providing resources and protocols enables clinicians to counsel about physical activity as part of every pediatric cardiology appointment. Evaluations of healthcare system impact and intervention delivery in small, medium and large clinics will assess applicability for implementation in all pediatric cardiac clinics. The impact on physical activity motivation and participation will evaluate the effectiveness of this standardized approach for increasing physical activity in children with congenital heart defects.
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Affiliation(s)
- Olivia Lemire
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jenna Yaraskavitch
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Andrew S Mackie
- Stollery Children's Hospital, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Schulich School of Medicine and Dentistry, Western University & Children's Health Research Institute, London, Ontario, Canada; Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany
| | - Jennifer Graham
- Canadian Congenital Heart Alliance, Toronto, Ontario, Canada
| | | | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.
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Mackie AS, Fournier A, Swan L, Marelli AJ, Kovacs AH. Transition and Transfer From Pediatric to Adult Congenital Heart Disease Care in Canada: Call For Strategic Implementation. Can J Cardiol 2019; 35:1640-1651. [DOI: 10.1016/j.cjca.2019.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/26/2019] [Accepted: 08/01/2019] [Indexed: 01/17/2023] Open
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Moons P, Luyckx K, Kovacs AH, Holbein CE, Thomet C, Budts W, Enomoto J, Sluman MA, Yang HL, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Apers S. Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease. Can J Cardiol 2019; 35:1842-1850. [DOI: 10.1016/j.cjca.2019.07.635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
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Goldberg DJ, Zak V, Goldstein BH, Schumacher KR, Rhodes J, Penny DJ, Petit CJ, Ginde S, Menon SC, Kim SH, Kim GB, Nowlen TT, DiMaria MV, Frischhertz BP, Wagner JB, McHugh KE, McCrindle BW, Shillingford AJ, Sabati AA, Yetman AT, John AS, Richmond ME, Files MD, Payne RM, Mackie AS, Davis CK, Shahanavaz S, Hill KD, Garg R, Jacobs JP, Hamstra MS, Woyciechowski S, Rathge KA, McBride MG, Frommelt PC, Russell MW, Urbina EM, Yeager JL, Pemberton VL, Stylianou MP, Pearson GD, Paridon SM. Results of the FUEL Trial. Circulation 2019; 141:641-651. [PMID: 31736357 DOI: 10.1161/circulationaha.119.044352] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Fontan operation creates a total cavopulmonary connection, a circulation in which the importance of pulmonary vascular resistance is magnified. Over time, this circulation leads to deterioration of cardiovascular efficiency associated with a decline in exercise performance. Rigorous clinical trials aimed at improving physiology and guiding pharmacotherapy are lacking. METHODS The FUEL trial (Fontan Udenafil Exercise Longitudinal) was a phase III clinical trial conducted at 30 centers. Participants were randomly assigned udenafil, 87.5 mg twice daily, or placebo in a 1:1 ratio. The primary outcome was the between-group difference in change in oxygen consumption at peak exercise. Secondary outcomes included between-group differences in changes in submaximal exercise at the ventilatory anaerobic threshold, the myocardial performance index, the natural log of the reactive hyperemia index, and serum brain-type natriuretic peptide. RESULTS Between 2017 and 2019, 30 clinical sites in North America and the Republic of Korea randomly assigned 400 participants with Fontan physiology. The mean age at randomization was 15.5±2 years; 60% of participants were male, and 81% were white. All 400 participants were included in the primary analysis with imputation of the 26-week end point for 21 participants with missing data (11 randomly assigned to udenafil and 10 to placebo). Among randomly assigned participants, peak oxygen consumption increased by 44±245 mL/min (2.8%) in the udenafil group and declined by 3.7±228 mL/min (-0.2%) in the placebo group (P=0.071). Analysis at ventilatory anaerobic threshold demonstrated improvements in the udenafil group versus the placebo group in oxygen consumption (+33±185 [3.2%] versus -9±193 [-0.9%] mL/min, P=0.012), ventilatory equivalents of carbon dioxide (-0.8 versus -0.06, P=0.014), and work rate (+3.8 versus +0.34 W, P=0.021). There was no difference in change of myocardial performance index, the natural log of the reactive hyperemia index, or serum brain-type natriuretic peptide level. CONCLUSIONS In the FUEL trial, treatment with udenafil (87.5 mg twice daily) was not associated with an improvement in oxygen consumption at peak exercise but was associated with improvements in multiple measures of exercise performance at the ventilatory anaerobic threshold. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02741115.
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Affiliation(s)
- David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Victor Zak
- New England Research Institutes, Watertown, MA (V.Z.)
| | - Bryan H Goldstein
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Kurt R Schumacher
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI (K.R.S., M.W.R.)
| | - Jonathan Rhodes
- Department of Cardiology, Children's Hospital Boston, MA (J.R.)
| | - Daniel J Penny
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (D.J.P.)
| | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P.)
| | - Salil Ginde
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (S.G., P.C.F.)
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (S.C.M.)
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon-Si, South Korea (S.-H.K.)
| | - Gi Beom Kim
- Seoul National University School of Medicine, Seoul National University Children's Hospital, South Korea (G.B.K.)
| | - Todd T Nowlen
- Heart Center, Phoenix Children's Hospital, AZ (T.T.N.)
| | - Michael V DiMaria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (M.V.D.)
| | - Benjamin P Frischhertz
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN (B.P.F.)
| | - Jonathan B Wagner
- Divisions of Cardiology and Clinical Pharmacology, Children's Mercy Kansas City, MO (J.B.W.)
| | - Kimberly E McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston (K.E.M.)
| | - Brian W McCrindle
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario (B.W.M.)
| | - Amanda J Shillingford
- Nemours Cardiac Center, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE (A.J.S.)
| | - Arash A Sabati
- Los Angeles Children's Hospital, Division of Cardiology, CA (A.A.S.)
| | - Anji T Yetman
- Children's Hospital and Medical Center, University of Nebraska, Omaha (A.T.Y.)
| | - Anitha S John
- Division of Cardiology, Children's National Health System, Washington, DC (A.S.J.)
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY (M.E.R.)
| | - Matthew D Files
- Division of Cardiology, Seattle Children's Hospital, WA (M.D.F.)
| | - R Mark Payne
- Division of Cardiology, Riley Hospital for Children, Indianapolis, IN (R.M.P.)
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada (A.S.M.)
| | | | | | - Kevin D Hill
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC (K.D.H.)
| | - Ruchira Garg
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (R.G.)
| | - Jeffrey P Jacobs
- Johns Hopkins All Children's Hospital, Department of Surgery, St Petersburg, FL (J.P.J.)
| | - Michelle S Hamstra
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Stacy Woyciechowski
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Kathleen A Rathge
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Peter C Frommelt
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (S.G., P.C.F.)
| | - Mark W Russell
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI (K.R.S., M.W.R.)
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - James L Yeager
- Consultant to Mezzion Pharma Co Ltd, Mezzion Pharma Co Ltd, Seoul, South Korea (J.L.Y.)
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Mario P Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
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Holbein CE, Peugh J, Veldtman GR, Apers S, Luyckx K, Kovacs AH, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Health behaviours reported by adults with congenital heart disease across 15 countries. Eur J Prev Cardiol 2019; 27:1077-1087. [DOI: 10.1177/2047487319876231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample. Design This was a cross-sectional observational study. Methods Adults with congenital heart disease ( n = 4028, median age = 32 years, interquartile range 25–42 years) completed self-report measures as part of the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS). Participants reported on seven health behaviours using the Health Behaviors Scale-Congenital Heart Disease. Demographic and medical characteristics were assessed via medical chart review and self-report. Multivariate path analyses with inverse sampling weights were used to investigate study aims. Results Health behaviour rates for the full sample were 10% binge drinking, 12% cigarette smoking, 6% recreational drug use, 72% annual dental visit, 69% twice daily tooth brushing, 27% daily dental flossing and 43% sport participation. Pairwise comparisons indicated that rates differed between countries. Rates of substance use behaviours were higher in younger, male participants. Optimal dental health behaviours were more common among older, female participants with higher educational attainment while sports participation was more frequent among participants who were younger, male, married, employed/students, with higher educational attainment, less complex anatomical defects and better functional status. Conclusions Health behaviour rates vary by country. Predictors of health behaviours may reflect larger geographic trends. Our findings have implications for the development and implementation of programmes for the assessment and promotion of optimal health behaviours in adults with congenital heart disease.
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Affiliation(s)
- Christina E Holbein
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, USA
| | - James Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Gruschen R Veldtman
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Saudi Arabia
| | - Silke Apers
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven - University of Leuven, Belgium
- UNIBS, University of the Free State, South Africa
| | - Adrienne H Kovacs
- Peter Munk Cardiac Center, University of Toronto, Canada
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Japan
| | - Maayke A Sluman
- Coronel Institute of Occupational Health, University of Amsterdam, the Netherlands
- Department of Cardiology, Jeroen Bosch Hospital, the Netherlands
| | - Chun-Wei Lu
- Adult Congenital Heart Center, National Taiwan University Children’s Hospital
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children’s Hospital, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Université de Montréal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children’s Hospital, USA
| | | | - Luis Alday
- Division of Cardiology, Hospital de Niños, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sweden
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Health Sciences, University West, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children’s Hospital, Canada
| | | | | | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, France
| | - Susan M Fernandes
- Adult Congenital Heart Program at Stanford, Lucile Packard Children’s Hospital and Stanford Health Care, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University, USA
- Barnes Jewish Heart and Vascular Center, University of Missouri, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center, University of Nebraska Medical Center, USA
- Taussig Heart Center, Johns Hopkins School of Medicine, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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49
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Ko JM, White KS, Kovacs AH, Tecson KM, Apers S, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, Callus E, Kutty S, Moons P, Cedars AM. Differential impact of physical activity type on depression in adults with congenital heart disease: A multi-center international study. J Psychosom Res 2019; 124:109762. [PMID: 31443808 DOI: 10.1016/j.jpsychores.2019.109762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to examine the association between physical activity (PA) and depression in a large international cohort of adults with congenital heart disease (ACHD) as data about the differential impact of PA type on depression in this population are lacking. METHODS In 2018, we conducted a cross-sectional assessment of 3908 ACHD recruited from 24 ACHD-specialized centers in 15 countries between April 2013 to March 2015. The Hospital Anxiety and Depression Scale was used to assess self-reported depressive symptoms and the Health-Behavior Scale-Congenital Heart Disease was used to collect PA information. Cochran-Armitage tests were performed to assess trends between depressive symptom levels and PA participation. Chi-Square and Wilcoxon Rank Sum tests were utilized to examine relations between depressive symptom levels and patient characteristics. Stepwise multivariable models were then constructed to understand the independent impact of PA on depressive symptoms. RESULTS The overall prevalence of elevated depressive symptoms in this sample was 12% with significant differences in rates between countries (p < .001). Physically active individuals were less likely to be depressed than those who were sedentary. Of the 2 PA domains examined, sport participation rather than active commute was significantly associated with reduced symptoms of depression. After adjustment in multivariable analysis, sport participation was still significantly associated with 38% decreased probability of depressive symptoms (p < .001). CONCLUSIONS Sport participation is independently associated with reduced depressive symptoms. The development and promotion of sport-related exercise prescriptions uniquely designed for ACHD may improve depression status in this unique population.
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Affiliation(s)
- Jong Mi Ko
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kamila S White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Adrienne H Kovacs
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Child and Adolescent Development, KU Leuven - University of Leuven, Leuven, Belgium
| | - Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease,Cardiovascular Center, Chiba, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology,Academic Medical Center, Amsterdam, The Netherlands
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Department of Pediatrics and Medicine, Divisions of Pediatric Cardiology and Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ari M Cedars
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Martin BJ, McBrien A, Marchak BE, Atallah J, Al Aklabi M, Mackie AS. Predicting Post-Fontan Length of Stay: The Limits of Measured Variables. Pediatr Cardiol 2019; 40:1208-1216. [PMID: 31230092 DOI: 10.1007/s00246-019-02134-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Post-operative length of stay (LOS) is an important metric for both healthcare providers and patients and their families. Predicting LOS is a challenge as it is sensitive to multitudinous patient and system factors. All subjects undergoing a Fontan from 1996-2016 who survived to hospital discharge were included. Details about the pre-operative status, operative conduct, and post-operative course of each patient were obtained. The association between patient characteristics and post-Fontan LOS were determined using stepwise multivariable regression models. Of 320 subjects who underwent a Fontan, 314 (98.1%) survived to hospital discharge. Median age at Fontan was 3.3 years (IQR 2.8, 4.0) and the most common underlying diagnosis was hypoplastic left heart syndrome (106, 33.8%). Median post Fontan LOS was 11 days (IQR 8, 17). Univariable risk factors for longer LOS included number of previous surgeries, post-Glenn LOS, cardiopulmonary bypass time, post-operative chylothorax, and failure to extubate in the operating room (all p < 0.05). In multivariable models, number of previous operations, extubation in the operating room, and postoperative complications predicted LOS (R2 = 0.5185 for full model). The proportion of patients discharged on week days (14.7-18.8% per day) was significantly higher than the proportion discharged on weekend days (5.1-9.9% per weekend day). Pre-operative variables have limited use in predicting post-Fontan length of stay. The most important predictors of post-operative LOS are extubation in the operating room and the occurrence of post-operative complications. However, a significant proportion of variability in LOS was not explained by available measurable variables.
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Affiliation(s)
- Billie-Jean Martin
- Department of Cardiothoracic Surgery, Falk Building, Stanford University, 870 Quarry Road, CV-225, Stanford, CA, 94304-5407, USA.
| | - Angela McBrien
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - B Elaine Marchak
- Department of Anesthesia, University of Alberta, Edmonton, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | | | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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