Weismann Constance G, Jafar Frishta, Hlebowicz Joanna
Department of Clinical Sciences Lund, Lund University, Sweden.
Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden.
Int J Cardiol Congenit Heart Dis. 2025 Apr 25;20:100588. doi: 10.1016/j.ijcchd.2025.100588. eCollection 2025 Jun.
Traditional cardiovascular risk factors put patients with congenital heart disease (CHD) at increased risk for acquired cardiovascular disease and mortality - more so than patients without CHD. In the general population, health related quality of life (HRQoL) is associated with regular physical activity. It was the aim of this study to evaluate the most important predictors of HRQoL in adults with CHD (ACHD).
This is a registry study using single center data collected between 2004 and 2022. Data include demographic data such as age and sex, body mass index (BMI) type of CHD, prior surgeries, physical activity and HRQoL using the EQ-5D-3L questionnaire. CHD severity was classified based on European Society of Cardiology (ESC) criteria. The cohort was divided based on self-reported levels of physical activity.
A total of 2469 patients were included in this study. 878 (25.6 %) patients had mild, 1151 (46.9 %) moderate and 329 (13.3 %) severe CHD. Patients with severe CHD had a lower BMI, HRQoL and were less physically active than those with mild-moderate CHD. Conversely, patients who were not doing regular exercise were significantly older, were more likely to be female, had a higher BMI, and had a lower HRQoL than their physically active peers. In a logistic regression model, physical activity was the most important predictor of a perfect HRQoL score in all five domains, especially if performed for ≥3 h/week (Odds ratios (OR) 2.1-7.5, all p < 0.001). In patients with severe CHD, HRQoL was disproportionately increased with even little exercise. Other important predictors of perfect HRQoL were younger age (OR 0.99, p < 0.001), male sex (OR 1.58, p < 0.001), mild-moderate CHD (OR 1.59, p < 0.001) and being of normal/overweight (OR 1.44, p < 0.001). Patients with underweight or obesity had a higher HRQoL only if execrising ≥3 h/week.
Regular physical activity in ACHD patients is associated with better HRQoL. Patients with underweight and obesity alike are also at risk for impaired HRQoL. We suggest that ACHD follow-up visits should include counseling on life-style issues in order to enhance HRQoL and minimize modifiable risk factors for acquired cardiovascular disease.
传统心血管危险因素使先天性心脏病（CHD）患者发生后天性心血管疾病和死亡的风险增加，比非CHD患者的风险更高。在普通人群中，健康相关生活质量（HRQoL）与规律的体育活动相关。本研究的目的是评估成年先天性心脏病患者（ACHD）中HRQoL的最重要预测因素。
这是一项使用2004年至2022年期间收集的单中心数据的注册研究。数据包括年龄和性别等人口统计学数据、体重指数（BMI）、CHD类型、既往手术、体育活动以及使用EQ-5D-3L问卷评估的HRQoL。CHD严重程度根据欧洲心脏病学会（ESC）标准进行分类。根据自我报告的体育活动水平对队列进行划分。
本研究共纳入2469例患者。878例（25.6%）患者患有轻度CHD，1151例（46.9%）患有中度CHD，329例（13.3%）患有重度CHD。重度CHD患者的BMI、HRQoL较低，体育活动也比轻度至中度CHD患者少。相反，不经常锻炼的患者比经常锻炼的同龄人年龄更大，更可能为女性，BMI更高，HRQoL更低。在逻辑回归模型中，体育活动是所有五个领域中HRQoL完美得分的最重要预测因素，尤其是每周进行≥3小时的体育活动时（优势比（OR）为2.1 - 7.5，所有p < 0.001）。在重度CHD患者中，即使少量运动，HRQoL也会不成比例地增加。HRQoL完美得分的其他重要预测因素包括年龄较小（OR 0.99，p < 0.001）、男性（OR 1.58，p < 0.001）、轻度至中度CHD（OR 1.59，p < 0.001）以及体重正常/超重（OR 1.44，p < 0.001）。体重过轻或肥胖的患者只有在每周锻炼≥3小时时HRQoL才较高。
ACHD患者进行规律的体育活动与更好的HRQoL相关。体重过轻和肥胖的患者HRQoL也有受损风险。我们建议ACHD随访应包括生活方式问题咨询，以提高HRQoL并尽量减少后天性心血管疾病的可改变危险因素。
