Nichtkardiale Komorbiditäten bei erwachsenen Patienten mit angeborenen Herzfehlern

Hauser, Michael; Lummert, Eckart; Braun, S.; Vigl, Matthaeus; Engelhardt, A.; Pujol, C.; Neidenbach, Rhoia; Oberhoffer, Renate; Ewert, Peter; Kaemmerer, Harald

doi:10.1007/s00398-016-0127-9

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Acquired co-morbidities, which occur frequently and have a lasting and unfavorable effect on the natural course of a CHD, are of particular relevance within a rehabilitation program for ACHD (53)(54)(55). In addition to acquired cardiovascular diseases (arterial hypertension, coronary heart disease, valvular diseases, endocarditis), this occurrence concerns the involvement of other organ systems, especially the lungs, pulmonary vessels, kidney, blood, coagulation system, central nervous system and metabolic disorders (diabetes mellitus, hyperlipidemia, hyperuricemia).…”

Section: Health Maintenance and Preventionmentioning

confidence: 99%

Lessons from the short- and mid-term outcome of medical rehabilitation in adults with congenital heart disease

Freilinger¹,

Andric²,

Andonian³

et al. 2021

Cardiovasc Diagn Ther

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Background: The number of adults with congenital heart disease (ACHD) is steadily increasing. Over their life-time, many of the affected patients require medical rehabilitation after interventional or surgical treatment of residua, sequels or complications of their congenital heart defect (CHD). However, up to now only scarce data exist about indication, performance and outcomes of cardiac rehabilitation in ACHD. Methods:The course and outcome of rehabilitation after previous interventional or surgical treatment in ACHD was analyzed in a retrospective cohort study.Results: Two hundred and five ACHD {54% female; mean age 34±12 [16-68] years} with mild (23.9%), moderate (35.1%) or severe CHD (41.0%), of whom 32% had complex CHD, 21% right-ventricular outflow tract obstructions, 20% pre-tricuspid shunts, 18% left heart or aortic anomalies, 9% post-tricuspid shunts and 2% other congenital cardiac anomalies were included into analysis. The main indications for rehabilitation were a preceding surgical (92%) or interventional (3%) treatment of the underlying CHD immediately before rehabilitation. During rehabilitation, no severe complications occurred. The number of patients in function class I/II increased from 189 to 200 and decreased in class III/IV from 16 to 5. Cardiac medication could be reduced or stopped after rehabilitation in 194 patients, with the exception of ACEinhibitors. There was an improvement in cardiovascular risk factors. While before medical treatment 77% (n=157) patients were capable of working, the number increased to 82% [168] at the end of rehabilitation.Throughout a follow-up 9.3% (n=19) of patients needed further cardiac interventions. Conclusions:The current study provided for the first time comprehensive data on the course of rehabilitation in a large cohort of ACHD after surgical or interventional treatment. The overall outcome of ACHD after rehabilitation was uneventful and favorable. Further research is required to assess the clinical long-term outcome, the impact of rehabilitation on the quality of life, disease coping and employment. The results of this study can serve as a benchmark for the development of specific rehabilitation programs in ACHD.

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Section: Health Maintenance and Preventionmentioning

confidence: 99%

Lessons from the short- and mid-term outcome of medical rehabilitation in adults with congenital heart disease

Freilinger¹,

Andric²,

Andonian³

et al. 2021

Cardiovasc Diagn Ther

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“…The number of children born with CHD per year is about 6,500 in Germany, 108,000 in Europe, and about 1.35 million worldwide (6)(7)(8). While in the 1930s, 80% of children with relevant CHD died in the first years of life, nowadays, more than 90% of CHD patients reach adulthood due to remarkable advances in cardiac surgery, paediatric cardiology, intensive care, and pharmacotherapy (6,9,10). It is estimated that, today, the number of adults living with CHD totals more than 330,000 in Germany, 2.3 million in Europe, and 12 to 34 million worldwide (11)(12)(13); the population of "adults with congenital heart defects" (ACHD) now exceeds the number of children with CHD.…”

Section: Introductionmentioning

confidence: 99%

Systematic assessment of health care perception in adults with congenital heart disease in Germany

Neidenbach¹,

Achenbach²,

Andonian³

et al. 2021

Cardiovasc Diagn Ther

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Background: The number of adults with congenital heart disease (ACHD) is steadily rising due to increased survival rate and improved medical resources. Accordingly, more than 330,000 ACHD are currently living in Germany. Almost all of them require lifelong specialized medical follow-up for their chronic heart disease, often accompanied by residua, sequelae, or comorbidities. Primary care physicians (PCPs) are a crucial factor in directing patients to ACHD specialists or specialized institutions, but despite all efforts, the number of ACHD under specialized care is low, the lost-to-follow-up rate is high, and the morbidity and mortality is substantial. The present cross-sectional study was designed to systematically characterize the health care of ACHD from a patient perspective, including (I) use of medical care by ACHD, (II) medical counselling needs, and (III) perceived satisfaction with health care. Methods:The German-wide analysis was based on a 25-item questionnaire designed to address different aspects of medical status and health issues of ACHD from their own perspective, performed between May of 2017 and July of 2020.Results: A total of 4,008 ACHD (52% female; mean age 41.9±17.2 years) completed the questionnaire. The majority of ACHD (3,524, 87.9%) reported, that they consulted their PCP for non-cardiac health problems, and 49.7% (n=1,991) consulted their PCP also for medical problems associated with the underlying CHD.Almost all ACHD reported a need for medical advice concerning exercise capacity and daily life activities, occupational skills, pregnancy, rehabilitation, genetic counselling, insurance, and retirement. A total of 1,840 (45.9%) patients were not aware of the existence of certified ACHD specialists or centers. Moreover, 2,552 (67.6%) of those surveyed were uninformed about patient organizations for ACHD. Conclusions:The present study demonstrates that ACHD are largely uninformed about the ACHD care structures available nationwide, although the patients have a great need for specialized follow-up, advice, and care.

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“…Although today most patients born with congenital heart disease (CHD) survive into adulthood, morbidity and mortality of CHD are still high (1). The natural and unnatural history is often complicated by residues and sequels of the particular CHD, which includes heart failure, pulmonary vascular disease, arrhythmias, multi-organ involvement, comorbidities and cardiac death (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the type of CHD and the treatment status, CHD patients may experience muscle mass loss due to low levels of physical activity. Functional exercise capacity and physical reserves are frequently reduced, and may denote patients at risk for hospitalization or death (2,5,6). In order to identify high-risk patients in time, not only an increased awareness of the treating physician is required, but also effective, easily available and cost-effective biomarkers.…”

Section: Introductionmentioning

confidence: 99%

The value of hand grip strength (HGS) as a diagnostic and prognostic biomarker in congenital heart disease

Neidenbach¹,

Oberhoffer²,

Pieper³

et al. 2019

Cardiovasc. Diagn. Ther.

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Background: In patients with congenital heart disease (CHD), there is little data on the diagnostic and prognostic relevance of hand grip strength (HGS) for clinical assignment, while in the general population the loss of muscle strength and mass is an important risk factor in cardiovascular disease which is conversely associated with morbidity and all-cause mortality. This study aimed to assess the degree of muscle dysfunction using HGS as a biomarker in a large group of patients with CHD who often develop muscle dysfunction.Methods: In total, 385 patients (27.6±13.1 years, 43% female) were included and assigned to 5 diagnostic groups: complex anomalies (n=131), left heart anomalies/aortopathies (n=107), right heart/pulmonary artery anomalies (n=92), primary left to-right-shunts (n=42) and miscellaneous CHD (n=13). Patients with Fontan circulation, chronic cyanosis, morphologic right systemic ventricle, arterial switch operation, or Ebstein's anomaly were analyzed separately. A control group (CG) consisted of 124 healthy individuals (30.1±12.1 years, 42% female). HGS was measured with a Jamar Hydraulic Hand Dynamometer.Results: HGS was reduced in CHD patients compared to controls (35.2±14.6 versus 43.7±14.4 kg). Most impairments were present in females (26.1±7.6 kg). Patients with cyanosis had lower HGS values compared to acyanotic CHD patients (P=0.03). Patients with left heart lesions had the highest HSG values (40.7±14.7 kg), while patients with primary left-to-right shunt lesions had the lowest HSG values (30.9±11.3 kg). Within specific groups of cardiac anomalies, patients with Fontan circulation showed the lowest (P=0.033) and patients with a morphologic right system ventricle showed higher results (P=0.004). The late mid-term survival was favorable, and 7 patients (1.8%) died in a median interval of 422 days (range, 206-1,824 days) after HGS-testing. Conclusions:This study provides the most comprehensive data on the use of HGS in CHD to date.Grip strength is an easily applicable, repeatedly usable and a cost-effective diagnostic tool to gain a quick, quantifiable assessment of the patient's current muscle function as an expression of cardiac fitness. Considering the low number of patients who died in the observation period, HGS may not be a suitable tool for survival assessment or identification of patients at risk. However, HGS is well suited to determine muscle function and strength and thereby to identify and to follow-up patients who have an increased cardiovascular risk.

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Nichtkardiale Komorbiditäten bei erwachsenen Patienten mit angeborenen Herzfehlern

Cited by 4 publications

References 21 publications

Lessons from the short- and mid-term outcome of medical rehabilitation in adults with congenital heart disease

Lessons from the short- and mid-term outcome of medical rehabilitation in adults with congenital heart disease

Systematic assessment of health care perception in adults with congenital heart disease in Germany

The value of hand grip strength (HGS) as a diagnostic and prognostic biomarker in congenital heart disease

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