Anxiety and Depression in Adults With Congenital Heart Disease.

Background: A comprehensive understanding of adult congenital heart disease outcomes must include psychological functioning. Our multisite study offered the opportunity to explore depression and anxiety symptoms within a global sample.

Objectives: In this substudy of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study), the authors we investigated the prevalence of elevated depression and anxiety symptoms, explored associated sociodemographic and medical factors, and examined how quality of life (QOL) and health status (HS) differ according to the degree of psychological symptoms.

Emergent Worldsheet for the AdS Virasoro-Shapiro Amplitude.

We construct a representation for the first anti-de Sitter curvature correction to the Virasoro-Shapiro amplitude, as an integral over the Riemann sphere. The integrand is that of the Virasoro-Shapiro amplitude in flat space, with the extra insertion of a linear combination of single-valued multiple polylogarithms of weight three. The integral representation implies an elegant, manifestly single-valued representation for the Wilson coefficients of the low-energy expansion.

Pure Anti-de Sitter Supergravity and the Conformal Bootstrap.

We consider graviton scattering in maximal supergravity on anti-de Sitter space (AdS) in d+1 dimensions for d=3, 4, and 6 with no extra compact spacetime factor. Holography suggests that this theory is dual to an exotic maximally supersymmetric conformal field theory (CFT) in d dimensions whose only light single trace operator is the stress tensor. This contrasts with more standard cases like type IIB string theory on AdS_{5}×S^{5} dual to N=4 super-Yang-Mills, where the CFT has light single trace operators for each Kaluza-Klein mode on S^{5}.

Patient-reported outcomes in the aging population of adults with congenital heart disease: results from APPROACH-IS.

The congenital heart disease (CHD) population now comprises an increasing number of older persons in their 6th decade of life and beyond. We cross-sectionally evaluated patient-reported outcomes (PROs) in persons with CHD aged 60 years or older, and contrasted these with PROs of younger patients aged 40-59 years and 18-39 years. Adjusted for demographic and medical characteristics, patients ≥60 years had a lower Physical Component Summary, higher Mental Component Summary, and lower anxiety (Hospital Anxiety and Depression Scale-Anxiety) scores than patients in the two younger categories.

Rationale, design and methodology of APPROACH-IS II: International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease.

Background: In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal.

Supersymmetric Five-Point Gluon Amplitudes in AdS Space.

We present the tree-level five-point amplitude of the lowest Kaluza-Klein mode of super-Yang-Mills theory on AdS_{5}×S^{3}, dual to the correlator of the flavor current multiplet in the dual 4d N=2 superconformal field theory. Its color and kinematical structure is particularly simple and resembles that of the flat-space gluon amplitude.

Heart Failure and Patient-Reported Outcomes in Adults With Congenital Heart Disease from 15 Countries.

Background Heart failure (HF) is the leading cause of mortality and associated with significant morbidity in adults with congenital heart disease. We sought to assess the association between HF and patient-report outcomes in adults with congenital heart disease. Methods and Results As part of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study), we collected data on HF status and patient-reported outcomes in 3959 patients from 15 countries across 5 continents.

Phenotypes of adults with congenital heart disease around the globe: a cluster analysis.

Objective: To derive cluster analysis-based groupings for adults with congenital heart disease (ACHD) when it comes to perceived health, psychological functioning, health behaviours and quality of life (QoL).

Methods: This study was part of a larger worldwide multicentre study called APPROACH-IS; a cross sectional study which recruited 4028 patients (2013-2015) from 15 participating countries. A hierarchical cluster analysis was performed using Ward's method in order to group patients with similar psychological characteristics, which were defined by taking into consideration the scores of the following tests: Sense Of Coherence, Health Behavior Scale (physical exercise score), Hospital Anxiety Depression Scale, Illness Perception Questionnaire, Satisfaction with Life Scale and the Visual Analogue Scale scores of the EQ-5D perceived health scale and a linear analogue scale (0-100) measuring QoL.

Patient-Reported Outcomes in Adults With Congenital Heart Disease Following Hospitalization (from APPROACH-IS).

In this international study, we (1) compared patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) who had versus had not been hospitalized during the previous 12 month, (2) contrasted PROs in patients who had been hospitalized for cardiac surgery versus nonsurgical reasons, (3) assessed the magnitude of differences between the groups (i.e., effect sizes), and (4) explored differential effect sizes between countries.

All Tree-Level Correlators for M Theory on AdS_{7}×S^{4}.

We present a constructive derivation of all four-point tree-level holographic correlators for eleven dimensional supergravity on AdS_{7}×S^{4}. These correlators correspond to four-point functions of arbitrary one-half BPS operators in the six-dimensional (2,0) theory at large central charge. The crucial observation is that the polar part of the correlators in Mellin space is fully captured by a drastically simpler maximally R-symmetry violating amplitude, while the contact part is fully fixed by superconformal Ward identities and the flat space limit.

Atrial arrhythmias and patient-reported outcomes in adults with congenital heart disease: An international study.

Background: Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD.

Objective: The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations.

Physical Functioning, Mental Health, and Quality of Life in Different Congenital Heart Defects: Comparative Analysis in 3538 Patients From 15 Countries.

Background: We compared physical functioning, mental health, and quality of life (QoL) of patients with different subtypes of congenital heart disease (CHD) in a large international sample and investigated the role of functional class in explaining the variance in outcomes across heart defects.

Methods: In the cross-sectional Assessment of Patterns of Patient-Reported Outcome in Adults with Congenital Heart Disease-International Study (APPROACH-IS), we enrolled 4028 adult patients with CHD from 15 countries. Diagnostic groups with at least 50 patients were included in these analyses, yielding a sample of 3538 patients (median age: 32 years; 52% women).

Sense of coherence in adults with congenital heart disease in 15 countries: Patient characteristics, cultural dimensions and quality of life.

Background: Previous studies have found that sense of coherence (SOC) is positively related to quality of life (QoL) in persons with chronic conditions. In congenital heart disease (CHD), the evidence is scant.

Aims: We investigated (i) intercountry variation in SOC in a large international sample of adults with CHD; (ii) the relationship between demographic and clinical characteristics and SOC; (iii) the relationship between cultural dimensions of countries and SOC; and (iv) variation in relative importance of SOC in explaining QoL across the countries.

Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries.

Background: The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied.

Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease.

Background: The prevalence and effects of cigarette smoking and cannabis use in persons with congenital heart disease (CHD) are poorly understood. We (1) described the prevalence of cigarette smoking, cannabis consumption, and co-use in adults with CHD; (2) investigated intercountry differences; (3) tested the relative effects on physical functioning, mental health, and quality of life (QOL); and (4) quantified the differential effect of cigarette smoking, cannabis use, or co-use on those outcomes.

Methods: APPROACH-IS was a cross-sectional study, including 4028 adults with CHD from 15 countries.

Implantable cardioverter-defibrillators and patient-reported outcomes in adults with congenital heart disease: An international study.

Background: Implantable cardioverter-defibrillators (ICDs) are increasingly being used to prevent sudden death in the growing population of adults with congenital heart disease (CHD). However, little is known about their impact on patient-reported outcomes (PROs).

Objective: The purpose of this study was to assess and compare PROs in adults with CHD with and without ICDs.

Health behaviours reported by adults with congenital heart disease across 15 countries.

Background: Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample.

Design: This was a cross-sectional observational study.

Differential impact of physical activity type on depression in adults with congenital heart disease: A multi-center international study.

Objective: This study aimed to examine the association between physical activity (PA) and depression in a large international cohort of adults with congenital heart disease (ACHD) as data about the differential impact of PA type on depression in this population are lacking.

Methods: In 2018, we conducted a cross-sectional assessment of 3908 ACHD recruited from 24 ACHD-specialized centers in 15 countries between April 2013 to March 2015. The Hospital Anxiety and Depression Scale was used to assess self-reported depressive symptoms and the Health-Behavior Scale-Congenital Heart Disease was used to collect PA information.

Perceived Health Mediates Effects of Physical Activity on Quality of Life in Patients With a Fontan Circulation.

Patients with a Fontan circulation are at risk of a sedentary lifestyle. Given the direct relationship between physical activity and health, promotion of physical activity has the potential to improve outcomes, including quality of life (QOL). This study aimed to describe self-reported physical activity levels in adult Fontan patients and examine associations between physical activity, perceived health status and QOL.

Education as important predictor for successful employment in adults with congenital heart disease worldwide.

Background: Conflicting results have been reported regarding employment status and work ability in adults with congenital heart disease (CHD). Since this is an important determinant for quality of life, we assessed this in a large international adult CHD cohort.

Methods: Data from 4028 adults with CHD (53% women) from 15 different countries were collected by a uniform survey in the cross-sectional APPROACH International Study.

Geographical variation and predictors of physical activity level in adults with congenital heart disease.

Background: Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease (CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.

Physical Activity-Related Drivers of Perceived Health Status in Adults With Congenital Heart Disease.

Data on the differential impact of physical activity on perceived health status (PHS) in a large adult congenital heart disease (ACHD) patient population are lacking. We conducted a cross-sectional assessment of 4,028 ACHD patients recruited from 24 ACHD-specialized centers in 15 countries across 5 continents to examine the association between physical activity and PHS in a large international cohort of ACHD patients. A linear analog scale of the EuroQol-5D 3 level version and the 12-item Short Form Health Survey-version 2 were used to assess self-reported health status and the Health-Behavior Scale-Congenital Heart Disease was used as a subjective measurement of physical activity type, participation, and level.

Religion and spirituality as predictors of patient-reported outcomes in adults with congenital heart disease around the globe.

Aims: Religion and spirituality can be resources for internal strength and resilience, and may assist with managing life's challenges. Prior studies have been undertaken primarily in countries with high proportions of religious/spiritual people. We investigated (i) whether being religious/spiritual is an independent predictor of patient-reported outcomes (PROs) in a large international sample of adults with congenital heart disease, (ii) whether the individual level of importance of religion/spirituality is an independent predictor for PROs, and (iii) if these relationships are moderated by the degree to which the respective countries are religious or secular.

A multinational observational investigation of illness perceptions and quality of life among patients with a Fontan circulation.

Objective: First, to compare QOL and illness perceptions between patients with a Fontan circulation and patients with anatomically simple defects (ie, atrial septal defects [ASD] or ventricular septal defects [VSD]). Second, to explore illness perceptions as a mediator of the association between congenital heart disease (CHD) diagnosis and QOL.

Design: Cross-sectional observational study.

Loop Corrections to Supergravity on AdS_{5}×S^{5}.

We consider the four-point correlator of the stress-energy tensor multiplet in N=4 super Yang-Mills theory. In the planar limit and at large 't Hooft coupling, such a correlator is given by the corresponding holographic correlation function in IIB supergravity on AdS_{5}×S^{5}. We consider subleading corrections in the number of colors, i.