Physical fitness and exercise in adults with congenital heart disease

Background: The population of patients with adult congenital heart disease (ACHD) is growing, and the estimated life expectancy has increased. Therefore, factors related to lifestyle, such as physical activity (PA), exercise, and the risk of lifestyle-related diseases, to which these patients may be more susceptible, are becoming increasingly important to study. Aim: The aim of this thesis was to increase understanding of physical fitness (muscle function, cardiorespiratory endurance), PA, and health-related quality of life (HRQoL) in patients with ACHD. Another aim was to study patients who have undergone heart surgery using existing arteries that may impact arterial blood supply to the affected arm, with special attention on the arm and spine, and determine whether exercise may improve physical fitness in patients with complex ACHD. Methods: Studies I and II were register-based cross-sectional studies including patients with different types of ACHD that aimed to assess muscle function and cardiorespiratory fitness, PA level and HRQoL. Study III was also a cross-sectional study and aimed to assess patients with coarctation of the aorta (CoA), a narrowing of the descending aorta, regarding muscle function, arm length and circumference, and spinal mobility. Study IV aimed to assess exercise training with or without supplemental oxygen in patients with complex ACHD with primary outcome measures VO2peak and muscle function. Results: Studies I and II found that patients with ACHD, even patients with less complicated ACHD, have lower isoinertial muscle function and impaired cardiorespiratory endurance compared to healthy reference values. Study III found that patients with CoA who had been operated on using the subclavian flap technique have impaired muscle function and reduced arm length and circumference. Exercise training with or without supplemental oxygen was safe for patients with the most complex ACHD, and the intervention was feasible. Conclusion: The results revealed impaired muscle function and cardiorespiratory endurance in patients with various types of ACHD. Patients may also have impaired muscle function and spinal mobility due to heart surgery. Even patients with less complicated ACHD exhibit impaired physical fitness, which suggests that tests of physical fitness should be offered to all patients with ACHD. Adapting to or maintaining a physically active lifestyle and good physical fitness is important in all patients with ACHD to, reduce the risk of lifestyle-related diseases. Even patients with complex ACHD and decreased physical fitness may be offered individually prescribed exercise to improve physical fitness

Functional muscle power in the lower extremity in adults with congenital heart disease

Background: We aimed to investigate functional muscular power in the lower extremity in adults with congenital heart disease (ACHD) and compare results with those of healthy persons. Secondarily, we set out to assess muscle power in relation to age, sex, and complexity of ACHD. Methods: Between 2013 and 2019, 1126 patients attended the ACHD Unit of Sahlgrenska University Hospital/Östra and performed a test battery to determine physical fitness. Of these patients, 559 who performed the Timed-Stands Test (TST)—which requires 10 stands from a chair at the maximal possible speed—were included in the study. Results: Patients with ACHD performed the TST slower than reference (14.6 s [12.0–18.0] vs. 11.7 s [9.8–14.3], p 65 years. Women with ACHD performed the TST more rapidly or according to reference in 21% of patients aged 18–39 years, 56% of patients aged 40–65 years, and 32% of patients aged >65 years. Men with ACHD performed the TST significantly faster than women with ACHD (p < 0.001). Conclusions: Decreased functional muscle power was observed in patients with ACHD and was most pronounced in patients aged 18–39 years. Decreased muscle power is important to detect and requires further assessment because it may contribute to an increased risk of falling and developing lifestyle related diseases

Symptoms, care consumption, and healthcare costs in hospitalized patients during the first wave of the COVID-19 pandemic.

BackgroundWe aimed to assess symptomatology post discharge from the hospital in patients with COVID-19 treated during the first wave of the COVID-19 pandemic, and to follow care consumption and healthcare costs six months post discharge.MethodsThis study was a descriptive observational study over time. Data were retrieved from the Sahlgrenska University (SU) hospital registry for patients admitted to an SU hospital during March 2020 to August 2020. Of these, 1014 received a questionnaire approximately six weeks post discharge regarding symptoms. Data regarding care consumption were retrieved from the registry in the Region Västra Götaland for 529 (52.2%) patients who completed the questionnaire. Of these, 466 patients were included in the analysis of care consumption.ResultsThere was a reported decrease in mobility from admission to discharge in both men (p = 0.02) and women (p = 0.01). The costs of inpatient care amounted to a total of 9 601 459.20 Euro (EUR). Symptoms were reported in 436 (93.6%) patients post discharge, of which weight loss during COVID-19 was most common in both men (n = 220, 77.5%) and women (n = 107, 58.8%). During six-month follow-up, 409 (87%) patients consumed care. Of the registered visits, 868 (27.1%) were related to a COVID-19 diagnosis. The total sum of outpatient care (i.e. visits with a registered COVID-19 diagnosis) was 77 311.30 EUR.ConclusionsAt discharge from the hospital, there was a decrease in mobility. Most patients had remaining sequelae post discharge. At six months post discharge, nearly 90% of patients had consumed care, with approximately 20% related to COVID-19. This indicates a persisting need for rehabilitation post discharge from hospital in patients treated for COVID-19

Men (n = 284) and women (n = 182) reporting symptoms post discharge after hospitalization owing to COVID-19, N = 466.

COVID-19, coronavirus disease 2019. Bold figures denote statistical significance.</p

Functional capabilities on admission and at discharge, N = 529.

Functional capabilities on admission and at discharge, N = 529.</p

Characteristics of the included patients, N = 529.

Characteristics of the included patients, N = 529.</p

Symptomatology, return to previous occupation and if the patient had sought care post discharge from hospitalization due to COVID-19, N = 466.

Symptomatology, return to previous occupation and if the patient had sought care post discharge from hospitalization due to COVID-19, N = 466.</p

Patient recruitment diagram.

BackgroundWe aimed to assess symptomatology post discharge from the hospital in patients with COVID-19 treated during the first wave of the COVID-19 pandemic, and to follow care consumption and healthcare costs six months post discharge.MethodsThis study was a descriptive observational study over time. Data were retrieved from the Sahlgrenska University (SU) hospital registry for patients admitted to an SU hospital during March 2020 to August 2020. Of these, 1014 received a questionnaire approximately six weeks post discharge regarding symptoms. Data regarding care consumption were retrieved from the registry in the Region Västra Götaland for 529 (52.2%) patients who completed the questionnaire. Of these, 466 patients were included in the analysis of care consumption.ResultsThere was a reported decrease in mobility from admission to discharge in both men (p = 0.02) and women (p = 0.01). The costs of inpatient care amounted to a total of 9 601 459.20 Euro (EUR). Symptoms were reported in 436 (93.6%) patients post discharge, of which weight loss during COVID-19 was most common in both men (n = 220, 77.5%) and women (n = 107, 58.8%). During six-month follow-up, 409 (87%) patients consumed care. Of the registered visits, 868 (27.1%) were related to a COVID-19 diagnosis. The total sum of outpatient care (i.e. visits with a registered COVID-19 diagnosis) was 77 311.30 EUR.ConclusionsAt discharge from the hospital, there was a decrease in mobility. Most patients had remaining sequelae post discharge. At six months post discharge, nearly 90% of patients had consumed care, with approximately 20% related to COVID-19. This indicates a persisting need for rehabilitation post discharge from hospital in patients treated for COVID-19.</div