Current state of home-based exercise interventions in patients with congenital heart disease: a systematic review

Heart ◽  
2019 ◽  
Vol 106 (5) ◽  
pp. 333-341 ◽  
Author(s):  
Michael Meyer ◽  
Leon Brudy ◽  
Luisa García-Cuenllas ◽  
Alfred Hager ◽  
Peter Ewert ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Exercise Intervention ◽  
Age Groups ◽  
Training Programme ◽  
Walking Distance ◽  
Promising Alternative ◽  
Exercise Interventions ◽  
Home Based

Home-based exercise training is a promising alternative to conventional supervised training for patients with congenital heart disease (CHD). Even though the beneficial effect of exercise interventions is well established in patients with CHD, knowledge concerning variety and utility of existing programmes is still lacking. Therefore, the aim of this review is to give an overview about existing home-based exercise interventions in patients with CHD. A systematic search was performed in PubMed, Cochrane, Scopus and PEDro (2008–2018) for relevant clinical trials that provided any kind of home-based exercise with patients with CHD. All articles were identified and assessed by two independent reviewers. Seven articles with 346 paediatric CHD (18 months to 16 years) and five articles with 200 adults with CHD (21–41 years) were included. Most studies performed a supervised home-based exercise intervention with children and adolescents exercising at least three times per week with duration of 45 min for 12 weeks. Reported outcome measurements were health-related quality of life and physical activity, but mostly exercise capacity measured as peak oxygen uptake that improved in four studies (1.2%, 7%, 7.7%, 15%; p<0.05), walking distance in two (3.5%, 19.5%, p<0.05,) or walking time (2 min, p=0.003) in one. The dropout rates were high (15%), and compliance to the training programme was not reported in the majority of the studies (58%). Home-based exercise interventions are safe, feasible and a useful alternative to supervised cardiac rehabilitation for all age groups of patients with CHD. Nevertheless, training compliance represents a major challenge.

scholarly journals Exercise training in paediatric congenital heart disease: fit for purpose?

2021 ◽  
pp. archdischild-2020-321390
Author(s):  
Nurul Hidayah Amir ◽  
Dan M Dorobantu ◽  
Curtis A Wadey ◽  
Massimo Caputo ◽  
A. Graham Stuart ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Exercise Training ◽  
Congenital Heart ◽  
Exercise Intervention ◽  
Interval Training ◽  
Daily Practice ◽  
Well Being ◽  
Healthy Children ◽  
Exercise Interventions

Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults’ cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.

scholarly journals The COngenital HeARt Disease in adult and Pulmonary Hypertension (COHARD-PH) registry: a descriptive study from single-center hospital registry of adult congenital heart disease and pulmonary hypertension in Indonesia

2020 ◽  
Author(s):  
Lucia Kris Dinarti ◽  
Anggoro Budi Hartopo ◽  
Arditya Damar Kusuma ◽  
Muhammad Gahan Satwiko ◽  
Muhammad Reyhan Hadwiono ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Congenital Heart ◽  
Clinical Presentation ◽  
Right Heart Catheterization ◽  
Walking Distance ◽  
Heart Catheterization ◽  
Single Center ◽  
Right Heart

Abstract Backgrounds: The COngenital HeARt Disease in adult and Pulmonary Hypertension (COHARD-PH) registry is the first registry for congenital heart disease (CHD) andCHD-related pulmonary hypertension (PH) in adults in Indonesia.The study aims to describethe demographics, clinical presentation, and hemodynamics data of adult CHD and CHD-related PH in Indonesia. Methods: The COHARD-PH registry is a hospital-based, single-center, and prospective registry which includes adult patients with CHD and CHD-related PH. The patients were enrolled consecutively. For this study, we evaluatedthe registry patients from July 2012 until July 2019. The enrolled patients underwent clinical examination, electrocardiography, chest x-ray, 6-minute walking test, laboratory measurement, and transthoracic and transesophageal echocardiography. Right heart catheterization was performed to measure hemodynamics and confirmthe diagnosis of pulmonary artery hypertension (PAH). Results: We registered 1012 patients during the study.The majority were young, adult females.The majority of CHD was secundum ASD (73.4%). The main symptom was dyspnea on effort. The majority of patients (77.1%)had already developed signs of PH assessed by echocardiography. The Eisenmenger syndrome was encountered in 18.7% of the patients. Based on the right heart catheterization, 66.9% of patients had developed PAH. Patients with PAH were significantly older,had lower peripheral oxygen saturation, had lower 6-minute walking distance, and higher NTproBNP. The NTproBNP level independently predicted the development of PAH among CHD. Conclusions: The COHARD-PH registry is the first Indonesian adult-CHD and CHD-related PH registry. The demographics, clinical presentation, and hemodynamics dataof this registry reflect the situation in developing countries which needs to be compared with similar registries from developed countries.

Abstract 18744: Rising Costs of Adult Congenital Heart Disease Care: Does Gender Matter?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David A Briston ◽  
Elisa Bradley ◽  
Aarthi Sabanayagam ◽  
Ali N Zaidi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Age Groups ◽  
The United States ◽  
Hospital Discharges ◽  
Gender And Age ◽  
Adult Congenital ◽  
Gender Based

Introduction: The profile of congenital heart disease (CHD) has shifted, now with more adults than children who have survived. Few studies have provided a global assessment of adult congenital heart disease (ACHD) healthcare cost in the United States. Methods: Data from the National Inpatient Sample (2002-2012) utilizing diagnostic ICD-9 codes for moderate and complex ACHD were analyzed. Hospital discharges, total billed and reimbursed amounts, gender and age disparities were evaluated. Results: There was an overall increase in ACHD discharges (Moderate CHD: 4,742 vs. 6,545, Severe CHD: 807 vs. 1,115), billed and reimbursed dollar amounts (Billed: $542,703,961 vs. $1,506,945,042, +178%; reimbursed: $221,417,779 vs. $432,797,543, +95%). Women had more discharges in 2002 but not in 2012 (men: women, 2002: 6,503 vs. 7,805; 2012: 7,715 vs. 7,200) [Figure 1A]. Gender-based billed amounts followed a similar trend (2002: $262,918,357 vs. $279,785,604; 2012: $844,923,857 vs. $$662,021,185; p=0.006) as did total reimbursed (2002: $107,766,175 vs. $113,651,604; 2012: $243,183,638 vs. $189,613,905, p=0.008) [Figure 1B,C]. Healthcare expenditure increased across all age groups: this was most prominent in the > 44 vs. 18-44 yr. group (Billed: $617,589,813 vs. $346,652,267, p<0.001; reimbursed: $136,013,528 vs. $75,366,237, p<0.001). Conclusions: We are the first to report a change in the rate of gender-based ACHD hospitalizations, whereby men now account for more hospitalizations in the U.S. As ACHD discharges, billed and reimbursed amounts continue to rise over the last decade, we are also the first to demonstrate increased expenditure in older (> 44 yrs.) ACHD patients, a pattern that we predict will continue to grow and requires future investigation.

Abstract 149: Utilization and Costs of Hospitalization among Adolescents and Young Adults with Congenital Heart Disease in California

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Yang Lu ◽  
Garima Agrawal ◽  
Roberta G Williams
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Population ◽  
Young Adulthood ◽  
Congenital Heart ◽  
Age Groups ◽  
Early Years ◽  
Charge Ratio ◽  
Care Utilization ◽  
Hospitalization Costs

Background: Congenital heart disease (CHD) often requires intensive surgeries and care, especially in the early years of a CHD patient. However, it is not well understood how their health care utilization and costs vary as CHD patients transition into young adulthood. Objective: We aim to identify the utilization patterns of hospitalization by age among CHD patients 10-29 years old and to measure the associated costs as compared with the general population in California. Methods: We utilized the California State Inpatient Database (SID) and the Healthcare Cost and Utilization Project (HCUP) Cost-to-Charge Ratio Files 2005-2009. By merging the two datasets, we obtained data on about 97% of all hospital discharge records in California including principal and secondary diagnoses, principal and secondary procedures, admission and discharge status, basic patient demographics, total charges, imputed total costs, and length of stay (LOS). Hospital discharges of CHD patients were identified by one or more principal or secondary ICD-9 diagnosis codes of 745.xx, 746.xx, or 747.xx. Utilization and cost patterns were compared to the general population by 5-year age groups (10-14, 15-19, 20-24, and 25-29). We then conducted a multivariate linear regression with the CHD population to understand how age and other factors influence costs of hospitalization per stay. Results: The average hospitalization costs per stay among CHD patients remain 2-3 times as high as that of the general population across all age groups ($21-31k vs. $7k-12k). However, the total hospitalization costs of the CHD population monotonically decrease as patients with CHD age into adulthood: in 2005-2009, the total costs were $75m in the 10-14 group, $74m in the 15-19 group, $50m in the 20-24 group and $48m in the 25-29 group, which represented 3.8%, 1.7%, 0.8%, 0.7% of the total costs in the general population of the respective age group. The decline in total costs by age among the CHD population manifested in both decreasing numbers of hospitalizations and lower costs per stay. Other observed trends include increasing fraction of admissions from the emergency department (ED), decreasing fraction of surgery-related hospitalizations, and shorter LOS as CHD population age into adulthood. Regression results within the CHD population 10-29 years old (n=9680) suggest that costs per stay were positively associated with LOS (+$2674, p<.001) and were negatively associated with being 25-29 years old (-$3240, p<.001), being female (-$1935, p<.001), having no surgeries (-$16758, p<.001) or other procedures performed ($21396, p<.001), and being admitted from the ED (-$3638, p<.001). Conclusion: The CHD population incurs lower hospitalization costs as they age into young adulthood.

A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units

2017 ◽  
Vol 34 (09) ◽  
pp. 839-844 ◽  
Author(s):  
Charleta Guillory ◽  
Liza Creel ◽  
Judith Livingtson ◽  
Tiffany McKee-Garrett ◽  
Regine Fortunov ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Intensive Care ◽  
Heart Disease ◽  
Newborn Screening ◽  
Neonatal Intensive Care ◽  
Congenital Heart ◽  
False Positive Rate ◽  
Age Groups ◽  
Critical Congenital Heart Disease ◽  
Efficient System

Objective The objective of this study was to implement a strategy for critical congenital heart disease (CCHD) newborn screening in the neonatal intensive care unit (NICU). Design A NICU-specific curriculum, screening algorithm, slide presentations, and templates of orders, policies, and procedures were developed into a toolkit for training NICU personnel. Screening was conducted on first and second screen pre- and postductal oxygen saturations (SpO2) on newborns admitted or transferred to the NICU. Results We trained 347 NICU personnel in 13 Texas hospitals, representing rural, suburban, and metropolitan settings. Key hospital staff submitted deidentified, case-based screening data. Of 4,621 NICU admissions, 80% received a first screen. Second screening rates were substantially lower in all gestational age groups. Screening rates on first and second screens were lowest among infants born < 28 weeks. For the first screen, SpO2 was lowest among the youngest gestational ages. The false positive rate was 2.3%. Conclusion CCHD screening in the NICU is challenging, given the complexities of the NICU population. A modified screening protocol that recognizes special circumstances of neonatal intensive care could facilitate a more efficient system.

scholarly journals The COngenital HeARt Disease in adult and Pulmonary Hypertension (COHARD-PH) registry: a descriptive study from single-center hospital registry of adult congenital heart disease and pulmonary hypertension in Indonesia

2020 ◽  
Author(s):  
Lucia Kris Dinarti ◽  
Anggoro Budi Hartopo ◽  
Arditya Damar Kusuma ◽  
Muhammad Gahan Satwiko ◽  
Muhammad Reyhan Hadwiono ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Congenital Heart ◽  
Clinical Presentation ◽  
Right Heart Catheterization ◽  
Walking Distance ◽  
Heart Catheterization ◽  
Single Center ◽  
Right Heart

Abstract Backgrounds: The COngenital HeARt Disease in adult and Pulmonary Hypertension (COHARD-PH) registry is the first registry for congenital heart disease (CHD) andCHD-related pulmonary hypertension (PH) in adults in Indonesia.The study aims to describethe demographics, clinical presentation, and hemodynamics data of adult CHD and CHD-related PH in Indonesia. Methods: The COHARD-PH registry is a hospital-based, single-center, and prospective registry which includes adult patients with CHD and CHD-related PH. The patients were enrolled consecutively. For this study, we evaluatedthe registry patients from July 2012 until July 2019. The enrolled patients underwent clinical examination, electrocardiography, chest x-ray, 6-minute walking test, laboratory measurement, and transthoracic and transesophageal echocardiography. Right heart catheterization was performed to measure hemodynamics and confirmthe diagnosis of pulmonary artery hypertension (PAH). Results: We registered 1012 patients during the study.The majority were young, adult females.The majority of CHD was secundum ASD (73.4%). The main symptom was dyspnea on effort. The majority of patients (77.1%)had already developed signs of PH assessed by echocardiography. The Eisenmenger syndrome was encountered in 18.7% of the patients. Based on the right heart catheterization, 66.9% of patients had developed PAH. Patients with PAH were significantly older,had lower peripheral oxygen saturation, had lower 6-minute walking distance, and higher NTproBNP. The NTproBNP level independently predicted the development of PAH among CHD. Conclusions: The COHARD-PH registry is the first Indonesian adult-CHD and CHD-related PH registry. The demographics, clinical presentation, and hemodynamics dataof this registry reflect the situation in developing countries which needs to be compared with similar registries from developed countries.

scholarly journals Inadequate Dosage May Lead to the Recurrence of Postoperative Pulmonary Hypertension in Patients With Congenital Heart Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Xinmei Li ◽  
Te Li
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Combination Therapy ◽  
Congenital Heart ◽  
Meta Analysis ◽  
Age Factors ◽  
Age Groups ◽  
Interventional Closure ◽  
First Choice ◽  
Intractable Problem

Background: Pulmonary arterial hypertension (PAH) associated with congenital heart disease (PAH-CHD) occurs predominantly among patients with uncorrected congenital heart disease (CHD). It is an intractable problem to control PAH continuously and stably after an operation.Methods: 1) OPLS-DA combined with S-plot was used to retrospectively analyze the results of preoperative and postoperative PAH and 39 biochemical indicators of 235 patients admitted to Fuwai Yunnan Cardiovascular Hospital from January 2019 to December 2020. 2) Combined with Meta-analysis, the recurrence in postoperative PAH was analyzed in terms of operation factors, doses administered, and age factors.Results: 1) 4 indicators (PAH, RBC, HGB, and CO2) that reflect the prognosis of patients had been found by OPLS-DA combined with S-plot. 2) The recurrence rate of postoperative PAH was 37.02%. The comprehensive therapeutic effect of interventional closure was better than that of surgical operation. PAH was not significantly higher again in patients who received either the instruction dose or the literature dose. Postoperative combination therapy (bosentan and sildenafil) was more effective than bosentan alone. Recovery after treatment was better in infants than in the other four age groups.Conclusion: OPLS-DA combined with S-plot was used for the first time to analyze clinical examination data. In this study, this method proved to be a feasible method for analyzing clinical data We recommend interventional closure as the first choice for patients with PAH-CHD. For postoperative oral therapy, we recommend the combination therapy (bosentan with sildenafil). To prevent the recurrence, the dose should be strictly prescribed according to the instructions, literature, or body surface area converted. Moreover, we recommend treatment at a young age in these patients.

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