RESUMO
The vast majority of children with congenital heart disease (CHD) in high-income countries survive into adulthood. Further, paediatric cardiac services have expanded in middle-income countries. Both evolutions have resulted in an increasing number of CHD survivors. Expert care across the life span is necessitated. In adolescence, patients transition from being a dependent child to an independent adult. They are also advised to transfer from paediatrics to adult care. There is no universal consensus regarding how transitional care should be provided and how the transfer should be organized. This is even more challenging in countries with low resources. This consensus document describes issues and practices of transition and transfer of adolescents with CHD, accounting for different possibilities in high-, middle-, and low-income countries. Transitional care ought to be provided to all adolescents with CHD, taking into consideration the available resources. When reaching adulthood, patients ought to be transferred to adult care facilities/providers capable of managing their needs, and systems have to be in place to make sure that continuity of high-quality care is ensured after leaving paediatric cardiology.
Assuntos
Cardiologia , Enfermagem Cardiovascular , Cardiopatias Congênitas , Pediatria , Transição para Assistência do Adulto , Adolescente , Adulto , Ásia , Austrália , Criança , Consenso , Cardiopatias Congênitas/terapia , Humanos , Nova Zelândia , Estados UnidosRESUMO
BACKGROUND: Influenza vaccination (IV) and Pneumococcus vaccination (PV) are recommended for patients with cardiometabolic diseases. This study aimed to evaluate the immunization rate of ambulatory cardiometabolic patients during the COVID-19 pandemic in the Americas. METHODS: Electronic surveys were collected from 13 Spanish speaking countries between 15 June and 15 July 2020. RESULTS: 4216 patients were analyzed. Mean age 60 (±15) years and 49% females. Global IV rate was 46.5% and PV 24.6%. Vaccinated patients were older (IV = 63 vs. 58 years; PV = 68 vs. 59, p < 0.01) but without gender difference. Vaccination rates were greater in higher-risk groups (65+, diabetics, heart failure), but not in coronary artery disease patients. In the Southern cone, the rate of IV and PV was approximately double that in the tropical regions of the Americas. In a multivariate model, geographic zone (IV = OR 2.02, PV = OR 2.42, p < 0.001), age (IV = OR 1.023, PV = OR 1.035, p < 0.001), and incomes (IV = OR 1.28, PV = OR 1.58, p < 0.001) were predictors for vaccination. CONCLUSIONS: During the COVID-19 pandemic, ambulatory patients with cardiometabolic diseases from the Americas with no evidence of COVID-19 infection had lower-than-expected rates of IV and PV. Geographic, social, and cultural differences were found, and they should be explored in depth.
RESUMO
Functional classification of children and adults with repaired and unrepaired congenital heart disease is a challenge for clinicians, due to the heterogeneity of congenital heart disease. Functional studies may be complemented with a stress echocardiogram, which analyzes the hemodynamic behavior of surgical repair zones, residuals, and sequelae. The integration of the anatomical and functional classification criteria developed for congenital heart disease and the results of a stress echocardiogram can establish a more precise functional classification. Stress echocardiograms also provide early diagnosis of functional complications of the congenital heart, allowing timely management decisions. This paper reviews the most important aspects of stress echocardiograms in pediatric and adult congenital heart disease, seeking to spark cardiologists' interest in extending its applications in congenital heart disease.
