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

Sebastian Freilinger; Dario Andric; Caroline Andonian; Jürgen Beckmann; Christa Bongarth; Hans Peter Einwang; Peter Ewert; Michael Hofbeck; Ann-Sophie Kaemmerer; Nicole Nagdyman; Renate Oberhoffer; Yskert von Kodolitsch; Harald Kaemmerer; Rhoia Neidenbach

doi:10.21037/cdt-20-727

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

Cardiovasc Diagn Ther. 2021 Dec;11(6):1416-1431. doi: 10.21037/cdt-20-727.

Authors

Sebastian Freilinger^#¹, Dario Andric^#^{1

2}, Caroline Andonian^{1

3}, Jürgen Beckmann^{3

4

5}, Christa Bongarth⁶, Hans Peter Einwang⁶, Peter Ewert¹, Michael Hofbeck⁷, Ann-Sophie Kaemmerer¹, Nicole Nagdyman¹, Renate Oberhoffer⁸, Yskert von Kodolitsch², Harald Kaemmerer¹, Rhoia Neidenbach¹

Affiliations

¹ Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany.
² University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Chair of Sportpsychology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
⁴ School of Human Movement and Nutrition Sciences, University of Queensland, Australia.
⁵ Health Research Institute, University of Limerick, Ireland.
⁶ Klinik Höhenried, Höhenried, Germany.
⁷ Tübingen University Hospital, Tübingen, Germany.
⁸ Department of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.

^# Contributed equally.

Abstract

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 ACE-inhibitors. 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.

Keywords: Adults with congenital heart disease (ACHD); medical health supply; prevention; primary health care; supply characteristics in congenital heart defects.