Background: Overweight and obesity have become a major public health concern in recent decades, particularly in patients with chronic health conditions like congenital heart disease (CHD). This systematic review elaborates on the prevalence and the longitudinal development of overweight and obesity in children and adults with CHD. Methods: A systematic literature search was conducted in PubMed, Cochrane, and Scopus from January 2010 to December 2020 on overweight and obesity prevalence in children and adults with CHD. Results: Of 30 included studies, 15 studies evaluated 5680 pediatric patients with CHD, 9 studies evaluated 6657 adults with CHD (ACHD) and 6 studies examined 9273 both pediatric patients and ACHD. Fifteen studies received the quality rating “good”, nine studies “fair”, and six studies “poor”. In children with CHD, overweight prevalence was between 9.5–31.5%, and obesity prevalence was between 9.5–26%; in ACHD, overweight prevalence was between 22–53%, and obesity was between 7–26%. The prevalence of overweight and obesity was thereby similar to the general population. Overweight and obesity have been shown to increase with age. Conclusion: The prevalence of overweight and obesity in children and adults with CHD is similar to the general population, demonstrating that the growing obesity pandemic is also affecting the CHD population.

Objective: Digital approaches have the potential to make activity promotion attractive and age-appropriate for children and adolescents. KIJANI is a mobile application aiming to increase physical activity (PA) in youth via gamification and augmented reality. This study investigates the user experience with KIJANI through a multimethod approach.Approaches: KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of collected step counts. With these coins, blocks can be bought, which can be used to create virtual buildings and landscapes and integrate these into the player's real-world environment via augmented reality. To evaluate the user experience, participants played KIJANI in groups of three for 25 min. Afterwards KIJANI was evaluated qualitatively with one-on-one semi-structured interviews as well as quantitatively with standardized questionnaires.Results: Overall, 22 participants (12.6 ± 1.7 years, 6 girls) were included in the study. The overall game concept and realization were well received by the target group. Study participants did have various and creative ideas for the further development of KIJANI. The majority ( n = 16) thought that using KIJANI would increase their PA level. User experience based on the UEQ scale was (mean ± SD): attractiveness (1.78 ± 1.82), perspicuity (2.15 ± 0.680), efficiency (0.67 ± 1.25), dependability, (1.21 ± 0.93), stimulation (1.24 ± 1.78), and novelty (1.27 ± 1.34).Conclusion: With these insights, a further step has been taken in the participatory development of KIJANI. Apps like KIJANI appear to be suitable for PA promotion in children and adolescents.

Aims: High-sensitive troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) are established prognostic biomarkers for cardiovascular (CV) morbidity and mortality and frequently used in symptomatic and/or hospitalized adults with congenital heart disease (ACHD). Their prognostic value in clinically stable ACHD has not yet been well established. This study investigates the predictive value of hs-TnT, NT-proBNP, and CRP for survival and CV events in stable ACHD. Methods and results: In this prospective cohort study, 495 outpatient ACHD (43.9 ± 10.0 years, 49.1% female) underwent venous blood sampling including hs-TnT, NT-proBNP, and CRP. Patients were followed up for survival status and the occurrence of CV events. Survival analyses were performed with Cox proportional hazards regression analysis and Kaplan–Meier curves. During a mean follow-up of 2.8 ± 1.0 years, 53 patients (10.7%) died or reached a cardiac-related endpoint including sustained ventricular tachycardia, hospitalization with cardiac decompensation, ablation, interventional catheterization, pacer implantation, or cardiac surgery. Multivariable Cox regression revealed hs-TnT (P = 0.005) and NT-proBNP (P = 0.018) as independent predictors of death or cardiac-related events in stable ACHD, whilst the prognostic value of CRP vanished after multivariable adjustment (P = 0.057). Receiver-operator characteristic curve analysis identified cut-off values for event-free survival of hs-TnT ≤9 ng/L and NT-proBNP ≤200 ng/L. Patients with both increased biomarkers had a 7.7-fold (confidence interval 3.57–16.40, P < 0.001) higher risk for death and cardiac-related events compared with patients without elevated blood values. Conclusion: Subclinical values of hs-TnT and NT-proBNP are a useful, simple, and independent prognostic tool for adverse cardiac events and survival in stable outpatient ACHD. Registration: German Clinical Trial Registry DRKS00015248.

Purpose: Psychological distress and anxiety are increased among adults with congenital heart disease (CHD). However, heart-focused anxiety (HFA) and its impact on peak oxygen uptake (V˙o _2peak) have not yet been studied in this patient cohort. This study investigates HFA in adults with CHD and whether HFA is associated with V˙o _2peak in these patients. Methods: In this cross-sectional study, HFA was assessed in 984 adults with various CHD (34.2 ± 11.2 yr, 44% female) by the cardiac anxiety questionnaire. In 708 of those (33.5 ± 10.6 yr, 42% female), additional cardiopulmonary exercise testing was performed to assess exercise capacity by measurement of V˙o _2peak. Results: Compared with the general population, this adult CHD population showed higher HFA in the total cardiac anxiety questionnaire score (z score; 1.32 ± 1.17; P < .001), as well as in the three subdomains anxiety, avoidance, and attention (all P < .001). The higher the HFA, the lower was the V˙o _2peak % predicted (r = −0.280, P < .001) independent of CHD diagnosis, CHD severity, and surgical status. The V˙o _2peak % predicted significantly differed between patients with no (85.9 ± 18.4% predicted), slight (80.4 ± 18.4% predicted), and severe HFA (74.2 ± 18.4% predicted) independent of CHD diagnosis, CHD severity, and surgical status (P < .001). Conclusion: This study shows that HFA is a common sequela in adults with CHD, and high HFA is associated with reduced V˙o _2peak. Psychological screening and counseling for HFA therefore seem indicated in the aftercare of adults with CHD.

Objective Resilience is a complex, yet rather unexplored topic in patients with congenital heart disease (CHD). The goal of this study was to assess and compare resilience in children with CHD with healthy controls during the COVID-19 pandemic. Design and patients From June 2020 to June 2021, 124 children with various CHDs (14.6±2.1 years, 49 girls) and 124 matched healthy controls (14.8±2.0 years, 49 girls) completed the Resilience Scale-11 short version. Results Resilience was significantly reduced in children with CHD compared with healthy controls (CHD: 59.0±10.0 vs healthy controls: 64.4±6.5, p<0.001). That reduction was prominent in all CHD subgroups except those with left heart obstruction (aortic stenosis and coarctation of the aorta) and patients with transposition of the great arteries. Complex CHD had the lowest resilience of 57.6±8.4 (p<0.001) after adjusting for age and sex according to group differences. There was no difference between native CHD and CHD with open-heart surgery (native: 59.5±12.2 vs surgery: 58.8±9.3, p=0.758). Conclusions Resilience was reduced in children and adolescents with CHD compared with healthy peers during the COVID-19 pandemic. Children with complex severity appeared to be particularly affected. These findings emphasise continued efforts to provide a holistic and multidisciplinary approach in medical aftercare of these patients and their families.