Reproductive Health in Congenital Heart Disease: Preconception, Pregnancy, and Postpartum
The prevalence of congenital heart disease (CHD) in pregnancy is rising due to the improved survival of patients with CHD into childbearing age. The profound physiological changes that occur during pregnancy may worsen or unmask CHD, affecting both mother and fetus. Successful management of CHD during pregnancy requires knowledge of both the physiological changes of pregnancy and the potential complications of congenital heart lesions. Care of the CHD patient should be based on a multidisciplinary team approach beginning with preconception counseling and continuing into conception, pregnancy, and postpartum periods. This review summarizes the published data, available guidelines and recommendations for the care of CHD during pregnancy.
Adherence and Exercise Capacity Improvements of Patients With Adult Congenital Heart Disease Participating in Cardiac Rehabilitation
Background As the number of adults with congenital heart disease increases because of therapeutic advances, cardiac rehabilitation (CR) is increasingly being used in this population after cardiac procedures or for reduced exercise tolerance. We aim to describe the adherence and exercise capacity improvements of patients with adult congenital heart disease (ACHD) in CR. Methods and Results This retrospective study included patients with ACHD in CR at New York University Langone Rusk Rehabilitation from 2013 to 2020. We collected data on patient characteristics, number of sessions attended, and functional testing results. Pre-CR and post-CR metabolic equivalent task, exercise time, and maximal oxygen uptake were assessed. In total, 89 patients with ACHD (mean age, 39.0â€‰years; 54.0% women) participated in CR. Referral indications were reduced exercise tolerance for 42.7% and post-cardiac procedure (transcatheter or surgical) for the remainder. Mean number of sessions attended was 24.2, and 42 participants (47.2%) completed all 36 CR sessions. Among participants who completed the program as well as pre-CR and post-CR functional testing, metabolic equivalent task increased by 1.3 (95% CI, 0.7-1.9; baseline mean, 8.1), exercise time increased by 66.4â€‰seconds (95% CI, 21.4-111.4â€‰seconds; baseline mean, 536.1â€‰seconds), and maximal oxygen uptake increased by 2.5â€‰mL/kg per minute (95% CI, 0.7-4.2â€‰mL/kg per minute; baseline mean, 20.2â€‰mL/kg per minute). Conclusions On average, patients with ACHD who completed CR experienced improvements in exercise capacity. Efforts to increase adherence would allow more patients with ACHD to benefit.
Emotions, Perceptions and Health Behaviors of Adult Congenital Heart Disease Patients during COVID-19 in New York City
Background: Adults with congenital heart disease (ACHD) have increased prevalence of mood and anxiety dis-orders. There are limited data regarding the influence of the COVID-19 pandemic on the mental health and health behaviors of these patients. Objective: The purpose is to evaluate the perceptions, emotions, and health behaviors of ACHD patients during the COVID-19 pandemic. Methods: In this cross-sectional study of ACHD patients, we administered surveys evaluating self-reported emotions, perceptions and health behaviors. Logistic regressions were performed to determine the adjusted odds of displaying each perception, emotion and health behavior based on predictor variables. Results: Ninety-seven patients (mean age 38.3 years, 46.4% female, 85.6% moderate or complex lesion) completed the survey. The majority of patients reported feeling moderately or very sad (63.1%), and 48.4% of patients identified themselves as feeling moderately or very anxious. The majority of patients perceived their risk of COVID-19 as moderate or high. Females were more likely to report feeling sad and anxious (95% CI 1.06"“10.96, p-value 0.039, and 95% CI 1.44"“15.30, p-value = 0.012, respectively), and were associated with higher odds of having a perceived increased risk of COVID-19 (95% CI 1.33"“10.59, p-value 0.012). There was no association between ACHD anatomic or physiologic classification and perceptions, emotions and health behaviors. Conclusions: Females were more likely to report feeling sad, anxious and an increased risk of COVID-19 in comparison to males. These findings indicate the need for mental health support and promotion of health behaviors during the pandemic amongst all ACHD patients, regardless of underlying condition.
ANATOMICAL AND PHYSIOLOGICAL CORRELATES DURING EXERCISE-INDUCED HYPERTENSION IN COARCTATION OF THE AORTA [Meeting Abstract]
COVID-19 in Adults With CongenitalÂ Heart Disease
BACKGROUND:Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. OBJECTIVES:This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. METHODS:Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. RESULTS:From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 Â± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (pÂ =Â 0.001), whereas anatomic complexity or defect group were not. CONCLUSIONS:COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
Femoral artery homograft for coronary artery plasty following arterial switch operation [Case Report]
Managing the adult congenital heart disease patient in the covid-19 pandemic"”a new york perspective
Adults with congenital heart disease (ACHD) are likely at increased risk for complications of COVID-19. ACHD centers should prepare to deliver routine cardiac care and support for patients with COVID-19 safely at home, as the number of COVID-19 infections worldwide continues to increase. This brief report aims to share the strategies we have used in our ACHD program to manage and treat our patients during this global health crisis at one of the initial epicenters of the pandemic in New York City, and offer suggestions for preparation for ACHD clinicians.
Identifying barriers in the home environment among urban community-dwelling older adults with functional difficulty: A multi-method pilot study
Homes in dense urban areas can present unique challenges to community-dwelling older adults. This multi-method pilot study explored home environment barriers among lower-income urban community-dwelling older adults with functional difficulty using the In-Home Occupational Performance Evaluation (N = 15). Additional data were collected from interviews with community service providers (N = 7). Home environment barriers, including clutter and stairs, limited the ability of many community dwelling adults to perform routine tasks. Service providers felt that home assessments were helpful for identifying problematic activities and barriers early on before they became larger problems, especially for older adults with limited social supports and mental health problems. Our findings support interdisciplinary interventions to reduce barriers in the home environments of older adults.
Development and Initial Testing of the Self-Care of Chronic Illness Inventory
AIM/OBJECTIVE:To develop and psychometrically test the Self-Care of Chronic Illness Inventory, a generic measure of self-care. BACKGROUND:Existing measures of self-care are disease-specific or behavior-specific; no generic measure of self-care exists. DESIGN/METHODS:Cross-sectional survey. METHODS:We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring and Self-Care Management. Each of the three scales is scored separately and standardized 0 to 100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from in-patient and out-patient settings at five sites in the United States and ResearchMatch. org. Dimensionality testing with confirmatory factor analysis preceded reliability testing. RESULTS:The Self-Care Maintenance scale (8 items, 2 dimensions: illness related and health promoting behavior) fit well when tested with a two-factor confirmatory model. Internal coherence reliability was estimated at .67. The Self-Care Monitoring scale (5 items, single factor) fit well and reliability was .81. The Self-Care Management scale (7 items, 2 factors: autonomous and consulting behavior), when tested with a two-factor confirmatory model, fit adequately. Internal coherence reliability was .71. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. CONCLUSION/CONCLUSIONS:The Self-Care of Chronic Illness Inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.
A Mixed Methods Evaluation of the Feasibility and Acceptability of an Adapted Cardiac Rehabilitation Program for Home Care Patients
Home care clinicians have an opportunity to improve care for post-hospitalization patients with cardiovascular disease. This mixed methods study examined the feasibility and acceptability of an adapted cardiac rehabilitation (CR) program for the home care setting. Surveys measuring patient self-care and knowledge were administered to patients (nÂ =Â 46) at baseline and at 30-day follow-up. Semi-structured interviews were conducted with patients (nÂ =Â 28) and home care clinicians (nÂ =Â 11) at completion of the program. All survey indicators demonstrated a trend towards improvement, with a statistically significant increase in the self-care management subscale (pÂ =Â 0.002). Qualitative analyses identified three patient themes (self-awareness, nutrition, motivation) and three clinician themes (systematic approach, motivation, patient selection process). Incorporating CR into the home care setting proved to be a feasible and acceptable approach to increasing access to CR services among elderly patients.