Prevalence and Effects of Cigarette Smoking,Cannabis Consumption,and Co-use in Adults From 15 Countries With Congenital Heart Disease

BackgroundThe prevalence and effects of cigarette smoking and cannabis use in persons with congenital heart disease (CHD) are poorly understood. We (1) described the prevalence of cigarette smoking, cannabis consumption, and co-use in adults with CHD; (2) investigated intercountry differences; (3) tested the relative effects on physical functioning, mental health, and quality of life (QOL); and (4) quantified the differential effect of cigarette smoking, cannabis use, or co-use on those outcomes.MethodsAPPROACH-IS was a cross-sectional study, including 4028 adults with CHD from 15 countries. Patients completed questionnaires to measure physical functioning, mental health, and QOL. Smoking status and cannabis use were assessed by means of the Health Behaviour Scale—Congenital Heart Disease. Linear models with doubly robust estimations were computed after groups were balanced with the use of propensity weighting.ResultsOverall, 14% of men and 11% of women smoked cigarettes only; 8% of men and 4% of women consumed cannabis only; and 4% of men and 1% of women used both substances. Large intercountry variations were observed, with Switzerland having the highest prevalence for smoking cigarettes (24% of men, 19% of women) and Canada the highest for cannabis use (19% of men, 4% of women). Cigarette smoking had a small negative effect on patient-reported outcomes, and the effect of cannabis was negligible. The effect of co-use was more prominent, with a moderate negative effect on mental health.ConclusionsWe found significant intercountry variability in cigarette and cannabis use in adults with CHD. Co-use has the most detrimental effects on patient-reported outcomes.     

Cognition,Physical Function,and Quality of Life in Older Patients With Acute Decompensated Heart Failure

BackgroundOlder adults with acute decompensated heart failure have persistently poor clinical outcomes. Cognitive impairment (CI) may be a contributing factor. However, the prevalence of CI and the relationship of cognition with other patient-centered factors such a physical function and quality of life (QOL) that also may contribute to poor outcomes are incompletely understood.Methods and ResultsOlder (≥60 years) hospitalized patients with acute decompensated heart failure were assessed for cognition (Montreal Cognitive Assessment [MoCA]), physical function (Short Physical Performance Battery [SPPB], 6-minute walk distance [6MWD]), and QOL (Kansas City Cardiomyopathy Questionnaire, Short Form-12). Among patients (N = 198, 72.1 ± 7.6 years), 78% screened positive for CI (MoCA of <26) despite rare medical record documentation (2%). Participants also had severely diminished physical function (SPPB 6.0 ± 2.5 units, 6MWD 186 ± 100 m) and QOL (scores of <50). MoCA positively related to SPPB (ß = 0.47, P < .001), 6MWD ß = 0.01, P = .006) and inversely related to Kansas City Cardiomyopathy Questionnaire Overall Score (ß = –0.05, P < .002) and Short Form-12 Physical Component Score (ß = –0.09, P = .006). MoCA was a small but significant predictor of the results on the SPPB, 6MWD, and Kansas City Cardiomyopathy Questionnaire.ConclusionsAmong older hospitalized patients with acute decompensated heart failure, CI is highly prevalent, is underrecognized clinically, and is associated with severe physical dysfunction and poor QOL. Formal screening may reduce adverse events by identifying patients who may require more tailored care.     

Quality of Life in Congenital Heart Disease Patients According to Their Anatomical and Physiological Classification

Background: Living well is as important as living longer. The objective of this study is to assess quality of life(QoL) in congenital heart disease (CHD) according to current AHA/ACC anatomical and physiological classifi-cation. Methods: Cross-sectional study examining the World Health Organization QoL Bref questionnaire(WHOQoL-Bref) in consecutive outpatient CHD patients from a single unit. Results: 191 CHD patients werestudied. Median age was 28 ± 13 years and 59% were male. 44 (23%), 115 (60%) and 33 (17%) CHD patientsshowed mild, moderate and great anatomical defects respectively while 69 (36%) patients were in physiologicalStage A, 27 (14%) in Stage B, 84 (44%) in Stage C and 11 (6%) in Stage D. No significant differences were seenin relation the anatomical classification and the different sections of the WHOQoL-Bref questionnaire. CHDpatients in Stages C and D had significant lower physical domain scores than patients in the Stage A (p <0.05). However, no significant differences were seen in the psychological, social relationships and environmentaldomains. The binary logistic regression analysis showed that having a higher educational level was a protectivefactor [OR 0.32 (95% CI, 0.12–0.87), p = 0.026] while being married or cohabit was a risk factor [OR 3.46(95% CI, 1.13–10.63), p = 0.030] for having a worse rated QoL. Meanwhile, having a worse functional class(NYHA ≥2) [OR 3.44 (95% CI, 1.20–9.81), p = 0.021] was associated with dissatisfaction with health. Conclusion:Patients with advanced physiological stages scored lower on the physiological domain. No statistical significancewas seen, according to the anatomical and physiological classification, in the psychological, social relationship andenvironmental domains.     

The Interface of Mental and Physical Health Phenomena in Later Life:

The convergence of the biologic and psychodynamic arenas relevant to aging have ramifications for research, services, and aging policy. A few models pertaining to mental health aspects of physical health and illness in the elderly are given. Related research is noted and case examples illustrate the dynamic interplay between mental and physical factors.     

Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients

BackgroundIntegrated care for comorbid depression and chronic medical disease improved physical and mental health outcomes in randomized controlled trials. The Veterans Health Administration (VA) implemented Primary Care–Mental Health Integration (PC-MHI) across all primary care clinics nationally to increase access to mental/behavioral health treatment, alongside physical health management.ObjectiveTo examine whether widespread, pragmatic PC-MHI implementation was associated with improved care quality for chronic medical diseases.Design, Setting, and ParticipantsThis retrospective cohort study included 828,050 primary care patients with at least one quality metric among 396 VA clinics providing PC-MHI services between October 2013 and September 2016.Main Measure(s)For outcome measures, chart abstractors rated whether diabetes and cardiovascular quality metrics were met for patients at each clinic as part of VA’s established quality reporting program. The explanatory variable was the proportion of primary care patients seen by integrated mental health specialists in each clinic annually. Multilevel logistic regression models examined associations between clinic PC-MHI proportion and patient-level quality metrics, adjusting for regional, patient, and time-level effects and clinic and patient characteristics.Key ResultsMedian proportion of patients seen in PC-MHI per clinic was 6.4% (IQR=4.7–8.7%). Nineteen percent of patients with diabetes had poor glycemic control (hemoglobin A1c >9%). Five percent had severely elevated blood pressure (>160/100 mmHg). Each two-fold increase in clinic PC-MHI proportion was associated with 2% lower adjusted odds of poor glycemic control (95% CI=0.96–0.99; p=0.046) in diabetes. While there was no association with quality for patients diagnosed with hypertension, patients without diagnosed hypertension had 5% (CI=0.92–0.99; p=0.046) lower adjusted odds of having elevated blood pressures.Conclusions and RelevancePrimary care clinics where integrated mental health care reached a greater proportion of patients achieved modest albeit statistically significant gains in key chronic care quality metrics, providing optimism about the expected effects of large-scale PC-MHI implementation on physical health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07287-2.KEY WORDS: Health services, Mental health, Diabetes, Hypertension, Veterans     

Use of Implantable Cardioverter-Defibrillators in Congenital Heart Disease and Pediatric Patients: Results from the German National Registry for Congenital Heart Defects

Background: Sudden cardiac death is a leading cause of death in patients with congenital heart disease (CHD). Risk stratification for implantable cardioverter defibrillators (ICD) remains difficult due to limited data about use and outcome of device therapy in CHD patients in larger community-based cohorts. Methods and results: Out of a dataset with more than 50,000 patients registered at the German National Register for Congenital Heart Defects, 109 patients (median age 35.5; IQR 23.75–46.00), 68 (62%) male) with an ICD were identified and were retrospectively analyzed. Although the number of implantations increased steadily throughout the investigated time interval from 2001 to 2015, only 0.2% of the CHD patients in the national register received an ICD. Indication for ICD implantation was secondary prevention in 84 patients (78%) and primary prevention in 24 patients (22%). 23 patients (21%) of the ICD patients received appropriate ICD therapy. 7 patients (6%) received an inappropriate ICD therapy. In 23 patients (21%) device complications were documented with a high number of lead fractures and insulation defects (n = 14,13%). Conclusion: The current study investigates the clinical uptake and use of ICD therapy based on a large national registry for CHD patients. Despite a steady increase in the number of implanted devices, ICD uptake remains relatively low, particularly for primary prevention. The data suggests a potential reluctance in utilization of device therapy in this patient cohort for primary prevention. Selecting patients in whom benefits outweigh the risks associated with lifelong ICD therapy remains challenging.     

Medical Resource Use,Costs, and Quality of Life in Patients With Acute Decompensated Heart Failure: Findings From ASCEND-HF

BackgroundThe Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) randomly assigned 7,141 participants to nesiritide or placebo. Dyspnea improvement was more often reported in the nesiritide group, but there were no differences in 30-day all-cause mortality or heart failure readmission rates. We compared medical resource use, costs, and health utilities between the treatment groups.Methods and ResultsThere were no significant differences in inpatient days, procedures, and emergency department visits reported for the first 30 days or for readmissions to day 180. EQ-5D health utilities and visual analog scale ratings were similar at 24 hours, discharge, and 30 days. Billing data and regression models were used to generate inpatient costs. Mean length of stay from randomization to discharge was 8.5 days in the nesiritide group and 8.6 days in the placebo group (P = .33). Cumulative mean costs at 30 days were $16,922 (SD $16,191) for nesiritide and $16,063 (SD $15,572) for placebo (P = .03). At 180 days, cumulative costs were $25,590 (SD $30,344) for nesiritide and $25,339 (SD $29,613) for placebo (P = .58).ConclusionsThe addition of nesiritide contributed to higher short-term costs and did not significantly influence medical resource use or health utilities compared with standard care alone.     

Physical and Mental Health Functioning of Urban HIV-Infected and Uninfected Mothers with Problem Drinking

Problem drinking is of great concern for mothers, especially those who are HIV-infected. We compared background characteristics, co-occurring drug use, and physical and mental health functioning of urban HIV-infected and uninfected mothers with problem drinking who were raising adolescents. Mothers in both groups reported similarly high levels of lifetime and current alcohol and drug use and poor physical and mental health. Health outcomes for mothers with problem drinking do not appear to be exacerbated by HIV status. Implications for intervention efforts with mothers and their adolescent children are discussed.     

Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients

Background

The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions.

Methods and Results

Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7–65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step‐by‐step closure of the right ventricular to the CA connections. No procedure‐related deaths occurred.

Conclusion

Congenital and post‐procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long‐term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail‐out strategies should be planned in all coronary interventions. (J Interven Cardiol 2013;26:287–294)

     

Peculiarities of Distribution of Catecholamines in the Myocardium of Patients With Congenital Heart Defects

Catecholamines and intracardiac hemodynamics were studied in 37 patients with congenital heart defects. Clinical investigation confirmed importance of assessment of functional state of myocardium based on information, obtained by measurement of catecholamines in the heart. Concentration of catecholamines among various nosological was affected by perfusion and hypoxia of myocardium as well as forms of hyperfunction of cardiac muscle.     

不同程度慢性心力衰竭患者心律失常及其心率变异性的临床研究

目的探讨不同程度慢性心力衰竭(CHF)患者心律失常及其心率变异性(HRV)的变化和临床意义。方法采用24h动态心电图监测67例不同程度慢性心力衰竭患者(CHF组)和30例健康者(对照组),对心律失常及HRV的时域和频域指标进行对比分析。结果 CHF组各级心功能均以室性期前收缩发生最高,时域和频域指标均低于对照组(P<0.05),随着心功能下降,室性期前收缩发生率越高,HRV值越低,自主神经功能受损越明显,与心功能损害程度一致。结论不同程度CHF患者以室性期前收缩为主,HRV各项指标能反映患者自主神经功能状态,联合检测有助于判断CHF患者病情严重程度、预后和早期干预治疗。     

Quality of Life and Congenital Heart Disease in Childhood and Adolescence

Advances in cardiac surgery techniques and early diagnosis have enabled the increased survival of individuals with congenital heart disease. The investigation of the quality of life in children and adolescents with congenital heart disease provides complementary information to clinical data that can assist in decision making on the part of health professionals. Although many studies have been conducted to investigate the quality of life of children and adolescents with congenital heart disease, the results prove to be contradictory; while some studies show that congenital heart disease can impact the quality of life, others describe a better perception of quality of life among children and adolescents who suffer from the disease when compared with healthy control subjects. The purpose of this study is to review the literature on the assessment of health related quality of life in children and adolescents with congenital heart disease, in order to systematize the existing knowledge on this topic today. It is observed that research seeks to investigate aspects of personality in cardiac patients, their coping strategies used and perceived social support, aiming at better understanding the association of these variables with the level of quality of life in this population.     

Longitudinal Health-Related Quality of Life Assessment in Children with Congenital Heart Disease

Objective: Health-related quality of life (HRQoL) has become animportant outcome measure for patients with congenital heart disease (CHD).The aim of this study was to evaluate the natural course of HRQoL from longitudinal assessment in children with CHD. Patients and Methods: From July2014 to February 2020 this longitudinal study recruited 317 children with CHD(113 girls, 35.6%) aged 6 to 18 years (11.6 ± 2.9 years). HRQoL was assessedwith the generic, self-reported and age-adapted KINDL^® questionnaire. Duringa mean follow-up period of 2.2 ± 1.3 years, 195 patients had one HRQoL reassessment, 70 two, 40 three and 12 patients four or more re-assessment, respective. Results: Overall HRQoL at baseline was 78.7 ± 9.3. During follow-up therewere no changes in HRQoL over time (0.03 [–0.01–0.07]; p = 0.195). In a linearmixed model neither CHD severity, the diagnostic subgroup, age, BMI, surgicalhistory nor gender could be linked to a change in HRQoL during the follow-uptime. Only children with higher age baseline (–0.48 [–0.85––0.11]; p = 0.010)had lower HRQoL. Same trend was seen for BMI (–0.19 [–0.41–0.03]; p =0.099). Conclusion: Older children with CHD have significantly worse HRQoL,but they evolve similarly to younger children over time. Since no demographic orclinical variable could be linked to the course of HRQoL, it seems that individualHRQoL courses are not predictable and routine HRQoL evaluations seem to benecessary for acute decision making in clinical practice.     

Hand Grip Strength Predicts Mortality and Quality of Life in Heart Failure: Insights From the Singapore Cohort of Patients With Advanced Heart Failure

BackgroundFrailty is prevalent among patients with heart failure (HF) and is associated with increased mortality rates and worse patient-centered outcomes. Hand grip strength (GS) has been proposed as a single-item marker of frailty and a potential screening tool to identify patients most likely to benefit from therapies that target frailty so as to improve quality of life (QoL) and clinical outcomes. We assessed the association of longitudinal decline in GS with all-cause mortality and QoL. Decline in GS is associated with increased risk of all-cause mortality and worse overall and domain-specific (physical, functional, emotional, social) QoL among patients with advanced HF.MethodsWe used data from a prospective, observational cohort of patients with New York Heart Association class III or IV HF in Singapore. Patients’ overall and domain-specific QoL were assessed, and GS was measured every 4 months. We constructed a Kaplan-Meier plot with GS at baseline dichotomized into categories of weak (≤ 5th percentile) and normal (> 5th percentile) based on the GS in a healthy Singapore population of the same sex and age. Missing GS measurements were imputed using chained equations. We jointly modeled longitudinal GS measurements and survival time, adjusting for comorbidities. We used mixed effects models to evaluate the associations between GS and QoL.ResultsAmong 251 patients (mean age 66.5 ± 12.0 years; 28.3% female), all-cause mortality occurred in 58 (23.1%) patients over a mean follow-up duration of 3.0 ± 1.3 years. Patients with weak GS had decreased survival rates compared to those with normal GS (log-rank P = 0.033). In the joint model of longitudinal GS and survival time, a decrease of 1 unit in GS was associated with a 12% increase in rate of mortality (hazard ratio: 1.12; 95% confidence interval: 1.05–1.20; P = < 0.001). Higher GS was associated with higher overall QoL (β (SE) = 0.36 (0.07); P = < 0.001) and higher domain-specific QoL, including physical (β [SE] = 0.13 [0.03]; P = < 0.001), functional (β [SE] = 0.12 [0.03]; P = < 0.001), and emotional QoL (β [SE] = 0.08 [0.02]; P = < 0.001). Higher GS was associated with higher social QoL, but this was not statistically significant (β [SE] = 0.04 [0.03]; P = 0.122).ConclusionsAmong patients with advanced HF, longitudinal decline in GS was associated with worse survival rates and QoL. Further studies are needed to evaluate whether incorporating GS into patient selection for HF therapies leads to improved survival rates and patient-centered outcomes.