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THE USE OF INDIVIDUALIZED EXERCISE PRESCRIPTION AND ACTIVITY TRACKERS TO PROMOTE PHYSICAL ACTIVITY IN CHILDREN WITH CONGENITAL HEART DISEASE
Abstracts
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children with CHD (p>0.35). All study groups were within the normal range for fine motor score (p>0.17). CONCLUSION: Treatment history is not associated with motor development outcomes among very young children treated in the current surgical era. Future research should examine the motor development deficits that occur among children with innocent murmurs and the lower total motor function scores with older age.
Heart and Stroke Foundation of Ontario 233 INNOCENT MURMUR BUT NOT CONGENITAL HEART DEFECT TREATMENT HISTORY IS ASSOCIATED WITH MOTOR SKILL DELAY AMONG TODDLERS SEEN IN A CARDIAC CLINIC E Ertel, N Cinanni, S Lee, G Shanmugam, K Adamo, N Barrowman, MS Tremblay, R Dillenburg, BW Timmons, PE Longmuir Ottawa, Ontario BACKGROUND:
Motor development delays have been documented among children with complex congenital heart defects, with cardiac surgery an identified risk factor. This study evaluated the gross and fine motor development of toddlers seen in a paediatric cardiac clinic for an innocent heart murmur or a congenital heart defect (simple to complex). METHODS: Cross-sectional assessments of motor development were completed among 102 toddlers (46 female), 12 to 47 months of age (mean 29.610.9 months) seen in a paediatric cardiac clinic. Children with diagnoses affecting motor development were excluded. Study groups were innocent murmur (n¼23), congenital heart defect (CHD) not requiring treatment (n¼35), CHD repaired without surgery (n¼15), surgical repair of CHD without cardiopulmonary bypass (n¼20), or surgical CHD repair with bypass (n¼9). Gross, fine and total (gross + fine) motor function outcomes were assessed with the Peabody Developmental Motor Scales-2. Linear regression evaluated the association between treatment history and motor development outcomes. T-tests evaluated the patient scores relative to published norms. RESULTS: CHD repair occurred at 102 317 days of age. Children who had a CHD repair had been hospitalized for a total of 8 13 days and were taking 1.7 2.1 medications. Children not requiring repair (innocent murmur or CHD without intervention) had been hospitalized for 3 6 days and were taking 1.0 1.8 medications. Gross motor function (betaSE¼6.31.6) and total motor quotient (8.62.6) were significantly lower (p¼0.01) among children with innocent murmurs compared to all CHD patient groups. Total motor quotient (gross + fine) was significantly lower (p¼0.01) with older age (0.20.1 per month of age). Fine motor function did not differ by study group (p¼0.32). Children with CHD had total scores within the normal range (p>0.25). Total motor quotient was significantly lower than published norms for children with innocent murmurs (mean difference: 7.9; 95% CI: 1.8, 14.0). Gross motor function was significantly lower (p<0.01) among children with innocent murmurs (mean difference: 5.9; 95% CI: 2.4, 9.3) but not
Heart and Stroke Foundation of Canada 234 THE USE OF INDIVIDUALIZED EXERCISE PRESCRIPTION AND ACTIVITY TRACKERS TO PROMOTE PHYSICAL ACTIVITY IN CHILDREN WITH CONGENITAL HEART DISEASE BN Morrison, AM DeSouza, C Voss, JE Potts, GG Sandor, KC Harris Vancouver, British Columbia BACKGROUND:
Children with congenital heart disease (CHD) are less active and less fit than children without CHD. Exercise prescription and activity trackers have been used in other populations to promote physical activity. We performed a pilot study to evaluate the feasibility and impact of exercise prescription in conjunction with activity trackers. Our aim is to determine the impact of activity trackers with exercise prescription on moderate-to-vigorous physical activity (MVPA), and sedentary time in children with CHD.
S124 METHODS:
We recruited children 10-18 years of age with CHD. Baseline testing included cardiopulmonary exercise testing and measurement of activity using an accelerometer (GT3X+ ActiGraph LLC; 15s epoch). Physical activity was assessed using the FITT (frequency, intensity, time and type) principle. Participants were randomised; those in the intervention group were given an exercise prescription and activity tracker (MOVband, Cleveland, OH) for 16 weeks. The control group did not receive exercise prescription or activity trackers. Exercise physiologists monitored the intervention group’s physical activity online and provided support on a bi-weekly basis. MVPA was assessed with an accelerometer after 16 weeks. We included those who met usual wear time criteria (2 days with 600 minutes wear time/day, allowing non-wear of 60 minutes of zeros, 2 minutes spike allowance <100 counts per minute (cpm)). Vertical acceleration counts were categorised into sedentary (<100cpm) and MVPA ( 2296cpm) reported as mean daily minutes of MVPA and % sedentary time (sedentary minutes relative to wear time). RESULTS: Eight children (age 13-16 years) participated in the study with 4 randomly allocated to the intervention group. Two were excluded due to wear time <2 days with the accelerometers; both in the control group. Three of four children in the intervention group increased MVPA (2.5 to 24.8 minutes) and decreased %sedentary time (2.3% to 6.1%), while the two control children decreased MVPA (6.9 and 9.6 minutes) and sedentary behaviour was unchanged (0%) or increased (4.0%). CONCLUSION: The use of exercise prescription with an activity tracker is feasible and associated with increases in MVPA and decreases in sedentary time in children with CHD. This new technology provides unique opportunities to promote and remotely monitor activity levels in this population. There is good compliance and tolerability of this device in children with CHD. A larger scale randomised trial is warranted to confirm the results of this pilot study and determine the impact of changes in activity levels on exercise capacity in children with CHD. 235 PREVALENCE AND CORRELATES OF SLEEP-DISORDERED BREATHING IN CONGENITAL HEART DISEASE M Chari, E Oechslin, C Ryan Toronto, Ontario BACKGROUND:
The prevalence of sleep-disordered breathing (SDB) is approximately 10% in the general population and is increased in those with comorbidities such as ischemic heart disease and stroke. The increased survival of patients with congenital heart disease (CHD) into adulthood elevates the risk of both ischemic heart disease and non-cardiovascular diseases. The aim of our study was to assess the prevalence and correlates of SDB in the CHD population at the Toronto Congenital Cardiac Centre for Adults (TCCCA). METHODS: This was a retrospective cross-sectional study of active CHD patients assessed for SDB via polysomnography between 1998 and 2014 from the TCCCA. Subjects were stratified into those with (apnea-hypopnea index (AHI) 5/hr) and without SDB (AHI < 5/hr. SDB was classified as per standard criteria.
Canadian Journal of Cardiology Volume 31 2015 RESULTS:
Of the 7167 active patients in TCCCA database, there were 156 with confirmed CHD who had assessment for SDB within the study period. Of these subjects, 63% were males and 37% females with a mean age of 37.9 14.5 years. SDB was present in 131 (83.9%) subjects. Of those in whom full polysomnography data was available (n ¼ 69), 7.7% had no SDB, 8.2% mild, 9.8% moderate, and 12.6% severe SDB. Those with SDB were significantly older (41 vs 33 years, p ¼ 0.029), and had a higher BMI (31.4 vs. 25.4kg/m2, p ¼ 0.01) than those without SDB. A history of congestive heart failure was significantly associated (p¼0.021) with SDB. CONCLUSION: Two percent of patients with CHD had screening performed for SDB. In those screened for SDB there was a very high prevalence. This suggests that many patients remain undiagnosed and that screening is imperative in this population. In keeping with studies in the general population, increased age and BMI were associated with SDB. 236 HOSPITAL READMISSION OF CONGENITAL HEART DISEASE PATIENTS IN CANADA S Islam, Y Yasui, P Kaul, AS Mackie Edmonton, Alberta BACKGROUND:
Hospital readmissions represent a vast burden on health care resources and in many cases are avoidable. However, little is known about hospital readmission in children or adults with congenital heart disease (CHD) in Canada. We assessed readmission rates among CHD patients stratified by age, sex, and severity of CHD from 2003 to 2012 in Canada and identified risk factors associated with hospital readmission. METHODS: A retrospective cohort study was conducted among CHD patients identified from the hospital discharge abstract database of the Canadian Institute for Health Information from 2003 to 2012. We identified all index hospitalizations and followed them for up to 12 months to determine the readmission rate. The readmission rate for a given period of time, which is a cumulative outcome, was determined using a Poisson regression model and also stratified by age, sex, and severity of CHD. Multivariable logistic regression analyses were performed to identify risk factors associated with readmission within 2 weeks and 1 month after discharge. RESULTS: The readmission rates per 1,000 CHD patients were 48 within 2 weeks, 83 within 1 month, 163 within 3 months, and 353 within 1 year. More adults were readmitted compared to children (5.4% vs. 4.2% at 2 weeks and 8.5% vs. 7.2% at 1 month). Patients age 65 years had a 1.4 to 1.8 times higher readmission rate compared to infants (p<0.001). Among children, infants showed significantly higher readmission rate at 2 weeks (p¼0.014), 1 month (p¼0.03) and 3 months (p<0.001). The readmission rates were 2.5 to 4.9 times higher in complex CHD patients (p<0.001) and 1.3 to 1.8 times higher in moderate CHD patients (p<0.001) than simple CHD patients. Independent risk factors for readmission within 2 weeks and 1 month were age 40 years, age < 1 year, male sex, longer index hospitalization stay, and complex CHD. In adults non-CHD
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children with CHD (p>0.35). All study groups were within the normal range for fine motor score (p>0.17). CONCLUSION: Treatment history is not associated with motor development outcomes among very young children treated in the current surgical era. Future research should examine the motor development deficits that occur among children with innocent murmurs and the lower total motor function scores with older age.
Heart and Stroke Foundation of Ontario 233 INNOCENT MURMUR BUT NOT CONGENITAL HEART DEFECT TREATMENT HISTORY IS ASSOCIATED WITH MOTOR SKILL DELAY AMONG TODDLERS SEEN IN A CARDIAC CLINIC E Ertel, N Cinanni, S Lee, G Shanmugam, K Adamo, N Barrowman, MS Tremblay, R Dillenburg, BW Timmons, PE Longmuir Ottawa, Ontario BACKGROUND:
Motor development delays have been documented among children with complex congenital heart defects, with cardiac surgery an identified risk factor. This study evaluated the gross and fine motor development of toddlers seen in a paediatric cardiac clinic for an innocent heart murmur or a congenital heart defect (simple to complex). METHODS: Cross-sectional assessments of motor development were completed among 102 toddlers (46 female), 12 to 47 months of age (mean 29.610.9 months) seen in a paediatric cardiac clinic. Children with diagnoses affecting motor development were excluded. Study groups were innocent murmur (n¼23), congenital heart defect (CHD) not requiring treatment (n¼35), CHD repaired without surgery (n¼15), surgical repair of CHD without cardiopulmonary bypass (n¼20), or surgical CHD repair with bypass (n¼9). Gross, fine and total (gross + fine) motor function outcomes were assessed with the Peabody Developmental Motor Scales-2. Linear regression evaluated the association between treatment history and motor development outcomes. T-tests evaluated the patient scores relative to published norms. RESULTS: CHD repair occurred at 102 317 days of age. Children who had a CHD repair had been hospitalized for a total of 8 13 days and were taking 1.7 2.1 medications. Children not requiring repair (innocent murmur or CHD without intervention) had been hospitalized for 3 6 days and were taking 1.0 1.8 medications. Gross motor function (betaSE¼6.31.6) and total motor quotient (8.62.6) were significantly lower (p¼0.01) among children with innocent murmurs compared to all CHD patient groups. Total motor quotient (gross + fine) was significantly lower (p¼0.01) with older age (0.20.1 per month of age). Fine motor function did not differ by study group (p¼0.32). Children with CHD had total scores within the normal range (p>0.25). Total motor quotient was significantly lower than published norms for children with innocent murmurs (mean difference: 7.9; 95% CI: 1.8, 14.0). Gross motor function was significantly lower (p<0.01) among children with innocent murmurs (mean difference: 5.9; 95% CI: 2.4, 9.3) but not
Heart and Stroke Foundation of Canada 234 THE USE OF INDIVIDUALIZED EXERCISE PRESCRIPTION AND ACTIVITY TRACKERS TO PROMOTE PHYSICAL ACTIVITY IN CHILDREN WITH CONGENITAL HEART DISEASE BN Morrison, AM DeSouza, C Voss, JE Potts, GG Sandor, KC Harris Vancouver, British Columbia BACKGROUND:
Children with congenital heart disease (CHD) are less active and less fit than children without CHD. Exercise prescription and activity trackers have been used in other populations to promote physical activity. We performed a pilot study to evaluate the feasibility and impact of exercise prescription in conjunction with activity trackers. Our aim is to determine the impact of activity trackers with exercise prescription on moderate-to-vigorous physical activity (MVPA), and sedentary time in children with CHD.
S124 METHODS:
We recruited children 10-18 years of age with CHD. Baseline testing included cardiopulmonary exercise testing and measurement of activity using an accelerometer (GT3X+ ActiGraph LLC; 15s epoch). Physical activity was assessed using the FITT (frequency, intensity, time and type) principle. Participants were randomised; those in the intervention group were given an exercise prescription and activity tracker (MOVband, Cleveland, OH) for 16 weeks. The control group did not receive exercise prescription or activity trackers. Exercise physiologists monitored the intervention group’s physical activity online and provided support on a bi-weekly basis. MVPA was assessed with an accelerometer after 16 weeks. We included those who met usual wear time criteria (2 days with 600 minutes wear time/day, allowing non-wear of 60 minutes of zeros, 2 minutes spike allowance <100 counts per minute (cpm)). Vertical acceleration counts were categorised into sedentary (<100cpm) and MVPA ( 2296cpm) reported as mean daily minutes of MVPA and % sedentary time (sedentary minutes relative to wear time). RESULTS: Eight children (age 13-16 years) participated in the study with 4 randomly allocated to the intervention group. Two were excluded due to wear time <2 days with the accelerometers; both in the control group. Three of four children in the intervention group increased MVPA (2.5 to 24.8 minutes) and decreased %sedentary time (2.3% to 6.1%), while the two control children decreased MVPA (6.9 and 9.6 minutes) and sedentary behaviour was unchanged (0%) or increased (4.0%). CONCLUSION: The use of exercise prescription with an activity tracker is feasible and associated with increases in MVPA and decreases in sedentary time in children with CHD. This new technology provides unique opportunities to promote and remotely monitor activity levels in this population. There is good compliance and tolerability of this device in children with CHD. A larger scale randomised trial is warranted to confirm the results of this pilot study and determine the impact of changes in activity levels on exercise capacity in children with CHD. 235 PREVALENCE AND CORRELATES OF SLEEP-DISORDERED BREATHING IN CONGENITAL HEART DISEASE M Chari, E Oechslin, C Ryan Toronto, Ontario BACKGROUND:
The prevalence of sleep-disordered breathing (SDB) is approximately 10% in the general population and is increased in those with comorbidities such as ischemic heart disease and stroke. The increased survival of patients with congenital heart disease (CHD) into adulthood elevates the risk of both ischemic heart disease and non-cardiovascular diseases. The aim of our study was to assess the prevalence and correlates of SDB in the CHD population at the Toronto Congenital Cardiac Centre for Adults (TCCCA). METHODS: This was a retrospective cross-sectional study of active CHD patients assessed for SDB via polysomnography between 1998 and 2014 from the TCCCA. Subjects were stratified into those with (apnea-hypopnea index (AHI) 5/hr) and without SDB (AHI < 5/hr. SDB was classified as per standard criteria.
Canadian Journal of Cardiology Volume 31 2015 RESULTS:
Of the 7167 active patients in TCCCA database, there were 156 with confirmed CHD who had assessment for SDB within the study period. Of these subjects, 63% were males and 37% females with a mean age of 37.9 14.5 years. SDB was present in 131 (83.9%) subjects. Of those in whom full polysomnography data was available (n ¼ 69), 7.7% had no SDB, 8.2% mild, 9.8% moderate, and 12.6% severe SDB. Those with SDB were significantly older (41 vs 33 years, p ¼ 0.029), and had a higher BMI (31.4 vs. 25.4kg/m2, p ¼ 0.01) than those without SDB. A history of congestive heart failure was significantly associated (p¼0.021) with SDB. CONCLUSION: Two percent of patients with CHD had screening performed for SDB. In those screened for SDB there was a very high prevalence. This suggests that many patients remain undiagnosed and that screening is imperative in this population. In keeping with studies in the general population, increased age and BMI were associated with SDB. 236 HOSPITAL READMISSION OF CONGENITAL HEART DISEASE PATIENTS IN CANADA S Islam, Y Yasui, P Kaul, AS Mackie Edmonton, Alberta BACKGROUND:
Hospital readmissions represent a vast burden on health care resources and in many cases are avoidable. However, little is known about hospital readmission in children or adults with congenital heart disease (CHD) in Canada. We assessed readmission rates among CHD patients stratified by age, sex, and severity of CHD from 2003 to 2012 in Canada and identified risk factors associated with hospital readmission. METHODS: A retrospective cohort study was conducted among CHD patients identified from the hospital discharge abstract database of the Canadian Institute for Health Information from 2003 to 2012. We identified all index hospitalizations and followed them for up to 12 months to determine the readmission rate. The readmission rate for a given period of time, which is a cumulative outcome, was determined using a Poisson regression model and also stratified by age, sex, and severity of CHD. Multivariable logistic regression analyses were performed to identify risk factors associated with readmission within 2 weeks and 1 month after discharge. RESULTS: The readmission rates per 1,000 CHD patients were 48 within 2 weeks, 83 within 1 month, 163 within 3 months, and 353 within 1 year. More adults were readmitted compared to children (5.4% vs. 4.2% at 2 weeks and 8.5% vs. 7.2% at 1 month). Patients age 65 years had a 1.4 to 1.8 times higher readmission rate compared to infants (p<0.001). Among children, infants showed significantly higher readmission rate at 2 weeks (p¼0.014), 1 month (p¼0.03) and 3 months (p<0.001). The readmission rates were 2.5 to 4.9 times higher in complex CHD patients (p<0.001) and 1.3 to 1.8 times higher in moderate CHD patients (p<0.001) than simple CHD patients. Independent risk factors for readmission within 2 weeks and 1 month were age 40 years, age < 1 year, male sex, longer index hospitalization stay, and complex CHD. In adults non-CHD