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Article ; Online: Reduced Physical Activity During COVID-19 in Children With Congenital Heart Disease: A Longitudinal Analysis.

Kuan, Mimi T Y / Hemphill, Nicole M / Harris, Kevin C

CJC pediatric and congenital heart disease

2022 Volume 1, Issue 5, Page(s) 219–225

Abstract: Background: Coronavirus disease 2019 (COVID-19) was associated with a reduction in physical activity in children with congenital heart disease (CHD) in early 2020. Given the increased cardiovascular risk of this population, optimizing cardiovascular ... ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) was associated with a reduction in physical activity in children with congenital heart disease (CHD) in early 2020. Given the increased cardiovascular risk of this population, optimizing cardiovascular health behaviour is important. The aim of the study is to determine how the ongoing COVID-19 pandemic has impacted longitudinal physical activity measures in children with CHD. Methods: As part of a prospective cohort study, children and adolescents aged 9-16 years old with moderate-to-complex CHD were recruited from British Columbia Children's Hospital and partnership clinics across British Columbia and the Yukon territory. Daily step counts were measured continuously over 3 years (2018-2021) with Fitbit Charge 2. School status during the COVID-19 pandemic was assessed with parent- or self-report survey. Results: A total of 102, 114, and 93 participants had valid Fitbit data during 2018, 2019, and 2020, respectively. There was a significant reduction in the annual mean step count for 2020 (8225 ± 4328 steps) compared with both 2018 (9416 ± 3770 steps) and 2019 (9533 ± 4114 steps) ( Conclusions: We demonstrated a significant decrease in physical activity and loss of seasonal patterns in children with CHD during 2020. These findings represent a worsening of the cardiovascular risk profile in children with CHD, who are already at an increased risk of adverse cardiovascular outcomes. Mitigation strategies are needed to optimize the cardiovascular health status of children with CHD as the pandemic persists.
Language	English
Publishing date	2022-06-17
Publishing country	United States
Document type	Journal Article
ISSN	2772-8129
ISSN (online)	2772-8129
DOI	10.1016/j.cjcpc.2022.05.006
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Article ; Online: Reduced Physical Activity During COVID-19 Pandemic in Children With Congenital Heart Disease.

Hemphill, Nicole M / Kuan, Mimi T Y / Harris, Kevin C

The Canadian journal of cardiology

2020 Volume 36, Issue 7, Page(s) 1130–1134

Abstract: Children with congenital heart disease (CHD) are at risk for both COVID-19 and secondary cardiovascular outcomes. Their increased cardiovascular risk may be mitigated through physical activity, but public health measures implemented for COVID-19 can make ...

Abstract	Children with congenital heart disease (CHD) are at risk for both COVID-19 and secondary cardiovascular outcomes. Their increased cardiovascular risk may be mitigated through physical activity, but public health measures implemented for COVID-19 can make physical activity challenging. We objectively measured the impact of the COVID-19 pandemic on physical activity, continuously measured by Fitbit step counts, in children with CHD. Step counts were markedly lower in late March and early April 2020, compared with 2019 and early March 2020. It is vital to understand how precautions for COVID-19 will affect the health of children with CHD, especially if they persist long term.
MeSH term(s)	Adolescent ; British Columbia ; COVID-19 ; Child ; Child Health ; Cohort Studies ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Databases, Factual ; Exercise/physiology ; Female ; Follow-Up Studies ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/epidemiology ; Heart Defects, Congenital/rehabilitation ; Hospitalization/statistics & numerical data ; Hospitals, Pediatric ; Humans ; Male ; Needs Assessment ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Prospective Studies ; Risk Factors
Keywords	covid19
Language	English
Publishing date	2020-05-05
Publishing country	England
Document type	Journal Article
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2020.04.038
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Article ; Online: Reduced Physical Activity During COVID-19 Pandemic in Children With Congenital Heart Disease

Hemphill, Nicole M. / Kuan, Mimi T.Y. / Harris, Kevin C.

Canadian Journal of Cardiology

2020 Volume 36, Issue 7, Page(s) 1130–1134

Keywords	Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2020.04.038
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Article ; Online: Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage.

Sheth, Kevin N / Solomon, Nicole / Alhanti, Brooke / Messe, Steven R / Xian, Ying / Bhatt, Deepak L / Hemphill, J Claude / Frontera, Jennifer A / Chang, Raymond C / Danelich, Ilya M / Huang, Joanna / Schwamm, Lee / Smith, Eric E / Goldstein, Joshua N / Mac Grory, Brian / Fonarow, Gregg C / Saver, Jeffrey L

JAMA neurology

2024

Abstract: Importance: Intracerebral hemorrhage (ICH) is the deadliest stroke subtype, and mortality rates are especially high in anticoagulation-associated ICH. Recently, specific anticoagulation reversal strategies have been developed, but it is not clear ... ...

Abstract	Importance: Intracerebral hemorrhage (ICH) is the deadliest stroke subtype, and mortality rates are especially high in anticoagulation-associated ICH. Recently, specific anticoagulation reversal strategies have been developed, but it is not clear whether there is a time-dependent treatment effect for door-to-treatment (DTT) times in clinical practice. Objective: To evaluate whether DTT time is associated with outcome among patients with anticoagulation-associated ICH treated with reversal interventions. Design, setting, and participants: This cohort study used data from the American Heart Association Get With The Guidelines-Stroke quality improvement registry. Patients with ICH who presented within 24 hours of symptom onset across 465 US hospitals from 2015 to 2021 were included. Data were analyzed from January to September 2023. Exposures: Anticoagulation-associated ICH. Main outcomes and measures: DTT times and outcomes were analyzed using logistic regression modeling, adjusted for demographic, history, baseline, and hospital characteristics, with hospital-specific random intercepts to account for clustering by site. The primary outcome of interest was the composite inpatient mortality and discharge to hospice. Additional prespecified secondary outcomes, including functional outcome (discharge modified Rankin Scale score, ambulatory status, and discharge venue), were also examined. Results: Of 9492 patients with anticoagulation-associated ICH and documented reversal intervention status, 4232 (44.6%) were female, and the median (IQR) age was 77 (68-84) years. A total of 7469 (78.7%) received reversal therapy, including 4616 of 5429 (85.0%) taking warfarin and 2856 of 4069 (70.2%) taking a non-vitamin K antagonist oral anticoagulant. For the 5224 patients taking a reversal intervention with documented workflow times, the median (IQR) onset-to-treatment time was 232 (142-482) minutes and the median (IQR) DTT time was 82 (58-117) minutes, with a DTT time of 60 minutes or less in 1449 (27.7%). A DTT time of 60 minutes or less was associated with decreased mortality and discharge to hospice (adjusted odds ratio, 0.82; 95% CI, 0.69-0.99) but no difference in functional outcome (ie, a modified Rankin Scale score of 0 to 3; adjusted odds ratio, 0.91; 95% CI, 0.67-1.24). Factors associated with a DTT time of 60 minutes or less included White race, higher systolic blood pressure, and lower stroke severity. Conclusions and relevance: In US hospitals participating in Get With The Guidelines-Stroke, earlier anticoagulation reversal was associated with improved survival for patients with ICH. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2024.0221
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Article: Reduced Physical Activity During COVID-19 Pandemic in Children With Congenital Heart Disease

Hemphill, Nicole M / Kuan, Mimi T Y / Harris, Kevin C

Can J Cardiol

Abstract	Children with congenital heart disease (CHD) are at risk for both COVID-19 and secondary cardiovascular outcomes. Their increased cardiovascular risk may be mitigated through physical activity, but public health measures implemented for COVID-19 can make physical activity challenging. We objectively measured the impact of the COVID-19 pandemic on physical activity, continuously measured by Fitbit step counts, in children with CHD. Step counts were markedly lower in late March and early April 2020, compared with 2019 and early March 2020. It is vital to understand how precautions for COVID-19 will affect the health of children with CHD, especially if they persist long term.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #176063
Database	COVID19

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Article: Evaluation of conventional troponin I testing for the detection of myocardial dysfunction in children.

McGovern, Eimear / Voss, Christine / Hemphill, Nicole M / Sanatani, Shubhayan / Barakauskas, Vilte / Harris, Kevin C

Paediatrics & child health

2020 Volume 26, Issue 2, Page(s) 103–107

Abstract: Objectives: Troponin is a marker of myocardial injury but is not well studied in children. Our primary objective was to ascertain the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional troponin ... ...

Abstract	Objectives: Troponin is a marker of myocardial injury but is not well studied in children. Our primary objective was to ascertain the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional troponin I for the detection of acute myocardial dysfunction in previously healthy children. Our secondary objective was to identify clinical predictors of myocardial dysfunction in the setting of elevated troponin. Study design: This was a retrospective chart review in a single, paediatric, tertiary care centre of troponin tests performed in all admitted children over a 4-year period. Demographics, symptoms, signs, chest x-ray, ECG, and echocardiogram abnormalities were documented. Myocardial dysfunction was presumed to be absent when the patient had a normal cardiac assessment, with or without echocardiography, and did not re-present. Results: From January 2014 through December 2017, 566 patients had troponin tested as a screen for myocardial injury. Troponin was positive in 38 of 566 cases (6.7%). Myocardial dysfunction was detected in 9 of 566 cases (1.6%). Troponin was elevated in six of nine cases of myocardial dysfunction. The sensitivity of conventional troponin I for detecting acute myocardial dysfunction was 66% (95% confidence interval [CI] 30 to 93%). The specificity was 94% (95% CI 92 to 96%). PPV was 16% (95% CI 6 to 31%) and NPV 99% (95% CI 98 to 100%). An abnormal ECG was more prevalent in patients with a true positive versus a false-positive troponin result (P=0.03). Conclusion: Troponin testing identified few cases of myocardial dysfunction. We found the test to have only 66% sensitivity. Troponin testing as a screen for myocardial injury in children has limited utility.
Language	English
Publishing date	2020-02-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxaa011
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Article ; Online: Children with congenital heart disease exhibit seasonal variation in physical activity.

Kuan, Mimi T Y / Voss, Christine / Lopez, Jimmy / Hemphill, Nicole M / Harris, Kevin C

PloS one

2020 Volume 15, Issue 11, Page(s) e0241187

Abstract: Objective: We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease.: Methods: Data were collected as part of a prospective cohort study at ... ...

Abstract	Objective: We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease. Methods: Data were collected as part of a prospective cohort study at BC Children's Hospital, Vancouver, Canada. Daily step counts of children aged 9-16 years with moderate-to-severe CHD were assessed continuously for 1-year via a commercial activity tracker (Fitbit Charge 2™). Physical activity levels were also assessed conventionally at one time-point via accelerometers (ActiGraph) and physical activity questionnaires. Results: 156 children (mean age 12.7±2.4 years; 42% female) participated in the study. Fitbit data (n = 96) over a 1-year period clearly illustrated seasonal peaks (late spring and autumn) and dips (winter and summer school holidays) in physical activity levels, with group mean values being below 12,000 steps per day throughout the year. According to conventional accelerometry data (n = 142), 26% met guidelines, which tended to differ according to season of measurement (spring: 39%, summer: 11%, fall: 20%, winter: 39%; p-value = 0.053). Questionnaire data (n = 134) identified that the most widely reported activities were walking (81%) and running (78%) with walking being the highest in summer and fall and running in winter and spring. Furthermore, regardless of overall activity levels the children exhibit similar seasonal variation. Conclusions: We demonstrated that physical activity level changes across seasons in children with CHD. It is important to be aware of these fluctuations when assessing and interpreting physical activity levels. Season specific counselling for physical activity may be beneficial in a clinical setting.
MeSH term(s)	Accelerometry/methods ; Adolescent ; Canada ; Child ; Climate ; Exercise/physiology ; Female ; Fitness Trackers ; Heart Defects, Congenital/physiopathology ; Humans ; Male ; Motor Activity/physiology ; Prospective Studies ; Schools ; Seasons ; Surveys and Questionnaires ; Walking/physiology
Language	English
Publishing date	2020-11-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0241187
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Article ; Online: Children with congenital heart disease exhibit seasonal variation in physical activity.

Mimi T Y Kuan / Christine Voss / Jimmy Lopez / Nicole M Hemphill / Kevin C Harris

PLoS ONE, Vol 15, Iss 11, p e

2020 Volume 0241187

Abstract: Objective We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease. Methods Data were collected as part of a prospective cohort study at BC ... ...

Abstract	Objective We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease. Methods Data were collected as part of a prospective cohort study at BC Children's Hospital, Vancouver, Canada. Daily step counts of children aged 9-16 years with moderate-to-severe CHD were assessed continuously for 1-year via a commercial activity tracker (Fitbit Charge 2™). Physical activity levels were also assessed conventionally at one time-point via accelerometers (ActiGraph) and physical activity questionnaires. Results 156 children (mean age 12.7±2.4 years; 42% female) participated in the study. Fitbit data (n = 96) over a 1-year period clearly illustrated seasonal peaks (late spring and autumn) and dips (winter and summer school holidays) in physical activity levels, with group mean values being below 12,000 steps per day throughout the year. According to conventional accelerometry data (n = 142), 26% met guidelines, which tended to differ according to season of measurement (spring: 39%, summer: 11%, fall: 20%, winter: 39%; p-value = 0.053). Questionnaire data (n = 134) identified that the most widely reported activities were walking (81%) and running (78%) with walking being the highest in summer and fall and running in winter and spring. Furthermore, regardless of overall activity levels the children exhibit similar seasonal variation. Conclusions We demonstrated that physical activity level changes across seasons in children with CHD. It is important to be aware of these fluctuations when assessing and interpreting physical activity levels. Season specific counselling for physical activity may be beneficial in a clinical setting.
Keywords	Medicine ; R ; Science ; Q
Subject code	380
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Fontan-Associated Liver Disease: Spectrum of Disease in Children and Adolescents.

Rathgeber, Steven L / Guttman, Orlee R / Lee, Anna F / Voss, Christine / Hemphill, Nicole M / Schreiber, Richard A / Harris, Kevin C

Journal of the American Heart Association

2020 Volume 9, Issue 1, Page(s) e012529

Abstract: Background Information is evolving on liver disease in pediatric patients with Fontan physiology. The purpose of this investigation is to evaluate the spectrum of liver disease in a pediatric population of patients with Fontan physiology and evaluate ... ...

Abstract	Background Information is evolving on liver disease in pediatric patients with Fontan physiology. The purpose of this investigation is to evaluate the spectrum of liver disease in a pediatric population of patients with Fontan physiology and evaluate transient elastography (TE) as a noninvasive marker of liver disease. Methods and Results We prospectively enrolled all children with Fontan physiology. All patients underwent comprehensive liver evaluation including liver enzymes (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase), aspartate transaminase to platelet ratio index, albumin, bilirubin, international normalized ratio, complete blood cell count, abdominal ultrasound, and TE. Transjugular liver biopsies and hemodynamic measurements were performed in a subset of patients. A total of 76 children (median, 11.7; interquartile range, 8.4-14.8 [56% male]) were evaluated, with 17 having a transjugular liver biopsy (median 14.8 years; interquartile range, 14.3-17.4). All biopsies showed pathological changes. The severity of liver pathology did not correlate with TE. There was a positive correlation between TE and time since Fontan (
MeSH term(s)	Adolescent ; Biomarkers/blood ; Biopsy ; Child ; Elasticity Imaging Techniques ; Female ; Fontan Procedure/adverse effects ; Heart Defects, Congenital/surgery ; Humans ; Liver Diseases/blood ; Liver Diseases/diagnosis ; Liver Diseases/etiology ; Liver Function Tests ; Male ; Predictive Value of Tests ; Prospective Studies ; Risk Factors ; Treatment Outcome
Chemical Substances	Biomarkers
Language	English
Publishing date	2020-01-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.119.012529
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Article ; Online: Physical Activity Is Associated With Better Vascular Function in Children and Adolescents With Congenital Heart Disease.

Lopez, Jimmy R / Voss, Christine / Kuan, Mimi T Y / Hemphill, Nicole M / Sandor, George G S / Harris, Kevin C

The Canadian journal of cardiology

2019 Volume 36, Issue 9, Page(s) 1474–1481

Abstract: Background: Aortic stiffness is an important marker of cardiovascular risk and is elevated in children and adolescents with congenital heart disease (CHD) compared with healthy children; however, in children with CHD, little is known about the ... ...

Abstract	Background: Aortic stiffness is an important marker of cardiovascular risk and is elevated in children and adolescents with congenital heart disease (CHD) compared with healthy children; however, in children with CHD, little is known about the interaction between aortic stiffness and physical activity-a key determinant of aortic stiffness. Methods: For this cross-sectional cohort study, we recruited children and adolescents aged 9-16 years with moderate-to-complex CHD from British Columbia Children's Hospital and travelling partnership clinics across the province of British Columbia and the Yukon territory. Mean daily minutes of moderate-to-vigorous physical activity were objectively assessed using an ActiGraph accelerometer worn over the right hip during waking hours for 7 days. Aortic pulse wave velocity (cm/s) was measured using standard 2-dimensional echocardiography and Doppler ultrasound. Results: Participants (n = 104, 61% male; 85% consent rate) had a mean (standard deviation) age of 12.4 (2.4) years. Daily moderate-to-vigorous physical activity was 46.7 (20.0) minutes/d, with 25% meeting guidelines of ≥ 60 minutes of moderate-to-vigorous physical activity per day. Mean (standard deviation) aortic pulse wave velocity was 490.5 (161.9) cm/s, which was not significantly different between cardiac diagnoses. Higher levels of moderate-to-vigorous physical activity were associated with lower aortic pulse wave velocity (r = -0.226, P = 0.021). Conclusion: In children and adolescents with CHD, higher levels of physical activity are associated with better vascular function. Given this association, promoting physical activity should be a high priority in the care of children and adolescents with CHD.
MeSH term(s)	Accelerometry ; Adolescent ; Child ; Cross-Sectional Studies ; Exercise/physiology ; Female ; Heart Defects, Congenital/physiopathology ; Humans ; Male ; Pulse Wave Analysis ; Vascular Stiffness/physiology
Language	English
Publishing date	2019-12-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2019.12.019
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