Risk of Pneumonia in Adults With Closed Versus Unclosed Atrial Septal Defect (from a Nationwide Cohort Study)

Nyboe, Camilla; Olsen, Morten; Nielsen‐Kudsk, Jens Erik; Johnsen, Søren Paaske; Hjortdal, Vibeke E.

doi:10.1016/j.amjcard.2014.03.063

Cited by 32 publications

(45 citation statements)

References 20 publications

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“…The inclusion criteria were met by 1168 patients diagnosed in one of 80 Danish hospitals since 1977 (inclusion of patients has previously been described) 16. The majority of patients (74%) were diagnosed in one of the four Danish university hospitals.…”

Section: Resultsmentioning

confidence: 99%

“…The use of the unique identification number permits identification of hospital records for several past decades. Classification of dates and diagnoses was re-examined to minimise error and all hospital records were validated for correct diagnosis, status and date of closure,16 which also enabled exclusion of patients with PFO. The following limitations should be considered when interpreting the results.…”

Section: Discussionmentioning

confidence: 99%

“…This nationwide cohort, based on national public registries in Denmark, has previously been used in the analysis of risk of pneumonia in patients with ASD 16. The predominantly unified Danish healthcare system is publically funded.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure

Nyboe

Olsen

Nielsen‐Kudsk

et al. 2015

Heart

117

108

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure

Nyboe

Olsen

Nielsen‐Kudsk

et al. 2015

Heart

117

108

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“…Patients with small, unrepaired ASD were once believed to be as healthy as the general population; however, this notion has been called into question. We have demonstrated that patients with a small, unrepaired ASD that persists into adult life have increased risk of premature death (mean age of death was 63 years), more chronic diseases, worse functional capacity, higher levels of stress, and lower scores on self‐assessed physical function compared to the general population …”

Section: Introductionmentioning

confidence: 99%

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Udholm

Nyboe

Jørgensen

et al. 2019

Congenital Heart Disease

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Objective For the first time, we wish to assess the psychiatric burden in adult patients living with small, unrepaired atrial septal defects (ASD) using register‐based data, combined with self‐reported measures on levels emotional distress and educational status. Design A descriptive study using both the unique Danish registries and validated psychiatric questionnaires and scales, including: The Symptom Checklist, Whiteley‐7, and Brief Illness Perception Questionnaire. Patients Adult patients with small, unrepaired ASD, diagnosed between 1953 and 2011. Outcome Measures Number of register‐based psychiatric diagnoses. Additionally, symptoms of anxiety, depression, somatization, health anxiety, illness perception, and levels of educational attainment compared to age‐ and gender‐matched individuals from the reference group. Results We identified 723 Danish patients with a small, unrepaired ASD. Approximately 17% of the patients eligible for inclusion had one or more psychiatric diagnoses. The most common diagnoses were neurotic, stress‐related, and somatoform disorders. A total of 140 patients (mean age 33 years) was included for examination of their mental health using psychiatric questionnaires and scales. Patients with small ASD had higher scores of depression and anxiety when compared to the reference group (0.57 ± 0.67 vs 0.39 ± 0.52; P < .001). Furthermore, patients reported more symptoms of somatization (0.51 ± 0.48 vs 0.34 ± 0.39; P < .001). Finally, a higher percentage of patients with an unrepaired ASD had no education beyond high school when compared to the reference group (33.3% vs 14.3%; P < .001) and a smaller proportion of patients had completed a short‐cycle higher education (6.5% vs 16.1%; P = .002). Conclusion Patients with a small, unrepaired ASD in adult life have more symptoms of anxiety, depression, and somatization compared to the reference group. Furthermore, fewer patients had no education beyond high school. These results support the guidelines that adults with small ASD warrants regular lifelong follow‐up in specialized clinics aware of not only adverse somatic outcome but also rates of depression and anxiety.

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“…2 Generally, they are untreated and follow-up varies since their natural history and prognosis is predominantly thought to be benign. 5,6 Exercise impairment is well known in adult patients with a hemodynamically significant ASD. A study by Nyboe et al, demonstrated that patients with a small, unrepaired ASD have an increased mortality when compared with the general population, thereby emphasizing a need for long-term medical follow-up even with these simple small defects.…”

Section: Introductionmentioning

confidence: 99%

Small unrepaired atrial septal defects display impaired exercise capacity compared with healthy peers

Udholm

Rex

Eckerström

et al. 2018

Congenital Heart Disease

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Objective: Adult patients with small, unrepaired atrial septal defects have an increased risk of pneumonia, atrial fibrillation, and stroke. Furthermore, they have higher late mortality than the background population. The functional capacity is unknown in these patients. Therefore, our objective was to determine exercise capacity in adult patients diagnosed with an unrepaired atrial septal defect compared to healthy controls. Design: A cross-sectional study.Patients: Adult patients with small, unrepaired atrial septal defects, aged 18-65, diagnosed between 1953 and 2011.Interventions: Cardiopulmonary exercise test was performed using an incremental bicycle test and gas exchange was measured using breath-by-breath technique.Outcome measures: Primary outcome was peak oxygen uptake, secondary outcome was maximal workload and ventilatory anaerobic threshold. Results:We included 32 patients previously diagnosed with a small, unrepaired atrial septal defect and 16 healthy, age-and gender-matched controls (age 36.3 ± 13 years).Patients were divided into two groups based on whether the atrial septal defect was open (age 36.3 ± 11 years) or spontaneously closed (age 36.8 ± 14 years) since time of diagnosis. No differences in demographic characteristics or weekly exercise levels were found. Both patient groups reached lower peak oxygen uptake (open: 31.7 ± 11 mL/kg/min; spontaneously closed: 29.7 ± 6.9 mL/kg/min) compared with controls (42.6 ± 6.1 mL/kg/min; P = .0001). Workload (open: 2.6 ± 1.0 watt/kg; spontaneously closed: 2.5 ± 0.6 watt/kg) and aerobic capacity (open: 21.4 ± 8.7 mL/ kg/min; spontaneously closed: 22.5 ± 6.5 mL/kg/min) was also poorer in patients compared to controls (workload: 3.5 ± 0.5 watt/kg; P = .0006, aerobic capacity: 31.3 ± 6.8 mL/kg/min; P = .0007). Conclusion:Adult patients with a diagnosis of small, unrepaired atrial septal defect have significantly impaired exercise capacity when compared to healthy controls.The impairment was present even if, by the time of assessment, the defect had closed spontaneously. The pathophysiological mechanisms behind the impaired exercise capacity demonstrated in these patients remain unexplained and will be a target for future work.

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Risk of Pneumonia in Adults With Closed Versus Unclosed Atrial Septal Defect (from a Nationwide Cohort Study)

Cited by 32 publications

References 20 publications

Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure

Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Small unrepaired atrial septal defects display impaired exercise capacity compared with healthy peers

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