Katarzyna Gierat-Haponiuk

Bio: Katarzyna Gierat-Haponiuk is an academic researcher from Gdańsk Medical University. The author has contributed to research in topics: GUCH & Cardiac surgery. The author has an hindex of 7, co-authored 34 publications receiving 148 citations.

Effect of complex cardiac rehabilitation on physical activity and quality of life during long-term follow-up after surgical correction of congenital heart disease

Abstract: Wstep: Waznym etapem leczenia doroslych pacjentow z wrodzonymi wadami serca po operacjach kardiochirurgicznych jest kompleksowa rehabilitacja kardiologiczna (CCR), jednak dostep do tej formy terapii jest wciąz ograniczony. Brakuje polskich wytycznych dotyczących prowadzenia CCR, w tym treningow kontrolowanych u ,,mlodych doroslych”, kilkanaście lat po zabiegu korygującym wrodzoną wade serca. Cel: Celem pracy byla ocena wplywu CCR na wydolnośc fizyczną, tolerancje wysilku, jakośc zycia i nasilenie objawow depresyjnych pacjentow w odleglym okresie po chirurgicznej korekcji wrodzonych wad serca. Metody: Do badania wlączono 57 pacjentow z wrodzonymi wadami serca (30 kobiet i 27 mezczyzn) w wieku 23 ± 3,4 roku, w okresie minimum 12 miesiecy po zabiegu zamkniecia ubytku w przegrodzie miedzykomorowej (VSD) lub ubytku w przegrodzie miedzyprzedsionkowej typu ostium secundum (ASD II). Wszystkim pacjentom zaproponowano udzial w programie CCR: 31 pacjentow wzielo udzial w programie (grupa Reh), natomiast 26 pacjentow odmowilo udzialu w programie CCR (grupa NReh). U wszystkich pacjentow wykonano wstepny test wysilkowy spiroergometryczny na cykloergometrze rowerowym, stosując protokol typu ramp o początkowym obciązeniu 20 W i przyroście obciązenia 10 W na minute. Test byl limitowany maksymalnym zmeczeniem i standardowymi wskazaniami do przerwania proby wysilkowej. Do oceny psychologicznej wykorzystano kwestionariusz Becka i test sluzący do oceny jakości zycia — Euro QoL 5D. Po 30 dniach od badania wstepnego ponownie oceniono pacjentow z obu grup, stosując takie same narzedzia badawcze jak we wstepnym badaniu. Wyniki: Podczas prob wysilkowych wszyscy pacjenci osiągneli maksymalny poziom zmeczenia na poziomie 15–17 punktow w skali Borga, bez towarzyszących powiklan. Spoczynkowy rytm serca byl nizszy w grupie Reh (74 ± 8/min) niz w grupie NReh (81 ± 14/min). Pacjenci z grupy Reh osiągneli istotnie wyzszy maksymalny rytm serca w czasie proby wysilkowej; rowniez wspolczynnik tetna maksymalnego byl wyzszy u osob trenujących. Obciązenie wysilkiem bylo nieistotnie wieksze, natomiast czas trwania wysilku znamiennie dluzszy w grupie Reh niz w grupie NReh, odpowiednio 144 W vs . 124 W (p = 0,121) oraz 14 min vs . 11 min (p = 0,001). Wyzsze szczytowe zuzycie tlenu (VO2peak) uzyskaly osoby z grupy Reh w porownaniu z pacjentami z grupy NReh (27,5 ml/kg/min vs . 23 ml/kg/min; p = 0,003). Wyzsze nasilenie objawow depresyjnych wg Becka po zakonczeniu programu stwierdzono w grupie NReh niz w grupie Reh (średnio 4,8 vs . 2,2 pkt; p = 0,59). Natomiast subiektywna i obiektywna jakośc zycia byla wyzsza w grupie Reh niz w grupie NReh, odpowiednio 89 vs . 74,4 pkt (p < 0,01) oraz 94 vs . 83 pkt (p < 0,01). Wnioski: Wdrozenie programu CCR poprawia wydolnośc fizyczną, tolerancje wysilku fizycznego, jakośc zycia i zmniejsza objawy depresyjne pacjentow w poźnym okresie po chirurgicznej korekcji wrodzonych wad serca. Wprowadzenie programu CCR wydaje sie celowe jako uzupelnienie holistycznej opieki w tej grupie pacjentow.

Exercise capacity and the quality of life late after surgical correction of congenital heart defects.

Abstract: Background : The long-term impact of surgical correction of congenital heart defects (CHD) on exercise capacity and quality of life (QoL) has not been well established. Aim : To evaluate exercise capacity, QoL, physical activity and depression in young adult patients with a history of congenital heart defect surgery (GUCH) for simple left-to-right shunts, and to compare these parameters with those obtained in healthy volunteers. Methods : The study group consisted of 30 young adults with congenital heart defects (14 males, 16 females), aged 18–36 (mean 24.6) years who underwent corrective cardiac surgery at least 10 years earlier. The control group comprised 30 healthy students (15 males, 15 females), aged 21–28 (mean 24.4) years. We performed cardiopulmonary exercise testing on bicycle ergometer, QoL and physical activity tests, and depression inventory. Results : In young adult GUCH patients the exercise parameters were lower when compared to healthy peers. The Stanford questionnaire showed that physical activity was diminished as well as QoL in EuroQoL5 test. The Beck inventory showed more expressed depression in GUCH group. Conclusions : The exercise capacity, physical activity and QoL of young adults with a history of surgical treatment of CHD are worse than observed in healthy peers, and the health status does not fulfil the definition of complete recovery. Kardiol Pol 2011; 69, 8: 810–815

Hybrid approach for closure of muscular ventricular septal defects

Abstract: Background The complexity of ventricular septal defects in early infancy led to development of new mini-invasive techniques based on collaboration of cardiac surgeons with interventional cardiologists, called hybrid procedures. Hybrid therapies aim to combine the advantages of surgical and interventional techniques in an effort to reduce the invasiveness. The aim of this study was to present our approach with mVSD patients and initial results in the development of a mini-invasive hybrid procedure in the Gdansk Hybrid Heartlink Programme (GHHP) at the Department of Pediatric Cardiac Surgery, Pomeranian Centre of Traumatology in Gdansk, Poland.

Miniinvasive interventional bridge to major surgical repair of critical aortic coarctation in a newborn with severe multiorgan failure

Abstract: A b s t r a c t We present a case of a severely ill newborn with complex coarctation, multiorgan failure and massive oedema, who was treated with emergency stenting of the isthmus on the second day of life, which was followed by surgical stent removal and repair of the arch on the 29 th day, after stabilization of his general status. Interventional percutaneous direct stent implantation was performed, using a coronary stent (Abbott Multi-Link Vision Coronary Stent 3.5 mm/ 15 mm, USA) to cover the area of the aortic isthmus in the newborn. The area from the origin of the left subclavian artery to the beginning of the descending thoracic aorta beneath the isthmus was widely expanded. Control angio - graphy showed normal size of the isthmus without a systolic gradient in the area. In the next 3 weeks the boy improved his general status, with normalization of liver and renal parameters, as well as resolution of the oedema, and under - went surgery on his 29 th day of life. The procedure of stent removal with aortic extended end-to-end anastomosis was performed without complications, and the infant was transferred to general paediatrics for further treatment. The strategy of miniinvasive interventional bridge to postpone major surgical repair was effective in the presented infant, with positive final results of both cardiological intervention and subsequent surgical repair.

Effects of outpatient followed by home-based telemonitored cardiac rehabilitation in patients with coronary artery disease

Abstract: Background: Cardiac rehabilitation (CR) has been shown to reduce the cardiovascular mortality of patients with coronary artery disease (CAD) and help people to return to professional work. Unfortunately, limited accessibility and low participation levels present persistent challenges in almost all countries where CR is available. Applying telerehabilitation provides an op­portunity to improve the implementation of and adherence to CR, and it seems that the hybrid form of training may be the optimal approach due to its cost–effectiveness and feasibility for patients referred by a social insurance institution. Aim: To present the clinical characteristics and evaluate the effects of hybrid: outpatient followed by home-based cardiac telerehabilitation in patients with CAD in terms of exercise tolerance, safety, and adherence to the programme. Methods: A total of 125 patients (112 men, 13 women) with CAD, aged 58.3 ± 4.5 years, underwent a five-week training programme (TP) consisting of 19–22 exercise training sessions. The first stage of TP was performed in the ambulatory form of CR in hospital; then, patients continued to be telemonitored TP at home (hybrid model of cardiac rehabilitation — HCR). Before and after completing CR, all patients underwent a symptom-limited treadmill exercise stress test. Adherence was reported by the number of dropouts from the TP. Results: The number of days of absence in the HCR programme was 1.50 ± 4.07 days. There were significant improvements (p < 0.05) in some measured variables after HCR in the exercise test: max. workload: 7.86 ± 2.59 METs vs. 8.88 ± 2.67 METs; heart rate (HR) at rest: 77.59 ± 12.53 bpm vs. 73.01 ± 11.57 bpm; systolic blood pressure at rest: 136.69 ± 17.19 mm Hg vs. 130.92 ± 18.95 mm Hg; double product at rest: 10623.33 ± 2262.97 vs. 9567.50 ± 2116.81; HRR1: 97.46 ± 18.27 bpm vs. 91.07 ± 19.19 bpm; and, NYHA class: 1.18 ± 0.48 vs. 1.12 ± 0.35. Conclusions: In patients with documented CAD, HCR is feasible and safe, and adherence is good. Most patients were on social rehabilitation benefit, had a smoking history, and suffered from hypertension, obesity, or were overweight. A hybrid model of CR improved exercise tolerance.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology.

Abstract: Improved medical care of congenital heart disease patients increased survival into adulthood from 15% in the 1960s to over 85% in the current era. As a consequence, the prevalence of adult congenital heart disease (ACHD) increased rapidly,1 which is estimated to be >1 million ACHD patients in North America and 1.2 million in Europe. The growing number and aging of ACHD patients led to an overall increase in hospitalizations over the last decade and a substantial increase in patients presenting with heart failure (HF) (∼20%).2 The incidence of first HF-admission was 1.2 per 1000 patient-years in the Dutch national ‘CONCOR’ registry. Patients admitted with HF had a five-fold higher risk of death than those not admitted. From the same registry, the mortality was 2.8% during a follow-up period of 24 865 patient-years. Chronic HF (26%) and sudden death (19%) were recorded most frequently. The median age at death from HF was 51.0 years (range: 20.3–91.2 years).3 In another ACHD cohort, sudden death (26%) was the most common cause of death, followed by progressive HF (21%) and perioperative death (18%).4 Although patients with ACHD may not readily report symptoms, clinical HF is documented in 22.2% of patients with a Mustard repair for transposition of the great arteries (TGAs), 32.3% with congenitally corrected transposition of the great arteries (ccTGA), and 40% of patients after Fontan palliation. ### Heart failure with impaired systolic ventricular function The aetiology and triggers of impaired systolic ventricular function in ACHD patients are summarized in Table 1 . View this table: Table 1 Pathophysiology of heart failure with impaired systolic function: triggers (examples) ### Heart failure with preserved systolic ventricular function This occurs less often in ACHD patients, but is associated with specific conditions such as Shone complex and restrictive …

EQ-5D in Central and Eastern Europe: 2000–2015

Abstract: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. An electronic database search was performed up to 1 July 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n = 11), Bulgaria (n = 6), Czech Republic (n = 18), Hungary (n = 47), Poland (n = 51), Romania (n = 2), Slovakia (n = 3) and Slovenia (n = 14). Cardiovascular (21 %), neurologic (17 %), musculoskeletal (15 %) and endocrine, nutritional and metabolic diseases (13 %) were the most frequently studied clinical areas. Overall, 112 (78 %) of the studies reported EQ VAS results and 86 (60 %) EQ-5D index scores, of which 27 (31 %) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened.

Cardiac rehabilitation using the Family-Centered Empowerment Model versus home-based cardiac rehabilitation in patients with myocardial infarction: a randomised controlled trial.

Abstract: Objective To determine if a hybrid cardiac rehabilitation (CR) programme using the Family-Centered Empowerment Model (FCEM) as compared with standard CR will improve patient quality of life, perceived stress and state anxiety of patients with myocardial infarction (MI). Methods We conducted a randomised controlled trial in which patients received either standard home CR or CR using the FCEM strategy. Patient empowerment was measured with FCEM questionnaires preintervention and postintervention for a total of 9 assessments. Quality of life, perceived stress, and state and trait anxiety were assessed using the 36-Item Short Form Health Survey (SF-36), the 14-item Perceived Stress, and the 20-item State and 20-item Trait Anxiety questionnaires, respectively. Results 70 patients were randomised. Baseline characteristics were similar. Ejection fraction was significantly higher in the intervention group at measurements 2 (p=0.01) and 3 (p=0.001). Exercise tolerance measured as walking distance was significantly improved in the intervention group throughout the study. The quality of life results in the FCEM group showed significant improvement both within the group over time (p Conclusions The family-centred empowerment model may be an effective hybrid cardiac rehabilitation method for improving the physical and mental health of patients post-MI; however, further study is needed to validate these findings. Clinical Trials.gov identifier NCT02402582. Trial registration number NCT02402582.