OP-048 Pilot Study of Rehabilitation Outcomes in 205 Adults with Congenital Heart Disease (ACHD)

Abstract

Pilot Study of Rehabilitation Outcomes in 205 Adults with Congenital Heart Disease (ACHD). Dario Andric, Hans Peter Einwang, Yskert Von Kodolitsch, Christa Bongarth, Sandra Hischke, Renate Oberhoffer, Michael Hofbeck, Claudia Pujol, Jurgen Horer, Peter Ewert, Harald Kaemmerer. University Heart Center, Hamburg, Germany; Department of Preventive Pediatrics Uptown MunichCampus D, Germany; Paediatric Cardiology, Pulmonology and Intensive Care Medicine Tubingen University Hospital, Germany; Deutsche Rentenversicherung Bayern Sud Klinik Hohenried, Germany; Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich; Department of Cardiovascular Surgery Clinic for Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich; Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany. Objective: Adults with congenital heart disease (ACHD) may require rehabilitation after intervention or surgery for heart defects. However, until today there is no published experience on the spectrum of ACHD and their outcomes after rehabilitation. Methods: We performed a retrospective analysis of 205 ACHD who underwent rehabilitation in a single institution and analyzed their cardiac anomalies, type of intervention, risk factors and gender. Included were only patients with clinical follow-ups. Results: Of the 205 patients 32%had complex congenital heart disease, 21% right-ventricular outflow tract obstructions, 20% pre-tricuspid shunts, 18% left-ventricular outflow tract obstructions, 9% post-tricuspid shunts, 2% other cardiac anomalies. The reason for rehabilitation was surgery for their congenital heart disease in 92%, intervention in 3%, various other reasons were present in the remaining persons. Of the included patients, 46%weremale and 54%were female with an average age of 34 12 years (range 16e68 years). Of these, 20%were active smokers, 15% had chronic arterial hypertension, 21% had hyperlipidemia, 4% had diabetes mellitus. The mean follow-up was 28 24 months (0.5 e 127 months). In NYHA III/IV functional class directly before and after rehabilitation, and at final follow-upwere 8%, 2%and 5%.Directly before and after rehabilitation and at final follow-up, 77%, 82%, 84% of the patients were deemed capable of work. Unfit for work were 0%, 3%, 2%, respectively. Conversely, in the same time the difference of the mean resting systolic blood pressure increased by 10 mmHg (95% CI 9e12 mmHg). The comparison of maximum watt at stress-tests during rehabilitation and at final follow-up was 94 31watts versus 138 58wattswith ameandifference of 47watts (95% confidence interval (CI) 41 e 54 watts) after baseline adjustment. During follow-up 1 patient developed stroke, 5 developed cardiac decompensation (2%), whereas the remaining patients did not develop severe cardiovascular complications. Conclusion: We present initial data on the spectrum of diseases and the risk factors, diseases and outcomes in a large cohort of ACHD who underwent rehabilitation after surgical or interventional treatment of their congenital heart defects. The over-all outcome of ACHD after rehabilitation appears favorable. However, further analysis is required to assess the impact of rehabilitation of life-quality, disease coping and employment. In any case, the results of this study can also serve as a benchmark for the development of specific rehabilitation programs in patients with other congenital anomalies.