Chun-Wei Lu

Aim: To explore how adults with congenital heart disease (ACHD) experience and express grit in the workplace. Design: Qualitative study using Husserl's descriptive phenomenology. Methods: Between March 2022 and June 2023, semi‐structured interviews were administered to 18 ACHD recruited from two medical centre outpatient departments. The collected data underwent analysis utilising Colaizzi's 7‐step analysis method, coupled with Lincoln and Guba's framework, to ensure credibility and trustworthiness. Results: The analysis revealed five prominent themes derived from the data: (a) career choices amid constraints; (b) adjustments to one's work environment for reasons of fatigue; (c) crises in the workplace arising from exceeding one's physical limits; (d) supportive networks for better health and job stability; (e) resilience at work for balance and fulfilment in life. Conclusion: Grit significantly influences life satisfaction and job performance among adults with congenital heart disease, highlighting its profound impact on their experiences. Patients exhibit perseverance in job pursuits, adapt work methods to manage physical fatigue, confront challenges during work crises, value family and societal support and aim for self‐satisfaction. These findings highlight the impact of grit and mental health on ACHD's lives and work, providing insights for better psychological support and interventions. Implications for the Profession: This study clarifies the need for healthcare professionals to incorporate workplace grit training and assessment into ACHD care. Impact: Recognising grit as a key factor in ACHD patients' lives informs holistic care, workplace inclusivity and policies that enhance their long‐term well‐being. Reporting Method: This study was performed in accordance with the COREQ guidelines. Patient or Public Contribution: No patient or public involvement.

Aim: To examine the relationship between frailty status, family functioning, and quality of life in adolescents with congenital heart disease (CHD). Background: Frailty is a rarely assessed health outcome in adolescents. Despite advances in paediatric CHD treatment, potential complications may cause frailty, affecting family dynamics and quality of life. Family support and early screening are vital to managing the symptoms of frailty associated with CHD. Design: Cross‐sectional study. Methods: During the period from July 2022 to August 2023, 302 adolescents aged between 12 and 18 who had received a diagnosis of CHD were assessed for frailty using criteria that included slowness, weakness, exhaustion, shrinkage/body composition, and diminished physical activity. Data were collected from assessments of grip strength, the 6‐min walk test, body mass index, triceps skinfold thickness, the PedsQL Multidimensional Fatigue Scale Adolescent, Physical Activity Questionnaire for Adolescents, the Family Adaptability, Partnership, Growth, Affection, and Resolve scale, and the PedsQL 3.0 Cardiac Module. All data were subjected to multiple linear regression analysis. Results: Frailty, as measured by exhaustion and diminished physical activity, was significantly more prevalent in adolescents with severe symptoms of CHD than in those without symptoms. Of the participants, 56.6% were prefrail, and 8.3% were frail. Adolescents who were frail and lived in dysfunctional families experienced a worse quality of life than participants with robust health and those with positive family functioning. Conclusion: Frailty and family dysfunction negatively affect the quality of life in adolescents with CHD. Impact: Developing programmes that detect frailty early and improve family functioning for adolescents with CHD is critical. Establishing guidelines for identifying frailty in this population can minimise adverse health effects and enhance familial relationships. Patient or Public Contribution: No patient or public involvement.

OBJECTIVES: The evaluation of Fontan-associated liver disease is often challenging. Diffusion-weighted magnetic resonance imaging can detect hepatic fibrosis from capillary perfusion and diffusion abnormalities from extracellular matrix accumulation. This study investigated its role in the evaluation of liver disease in Fontan patients and explored possible diagnostic methods for early detection of advanced liver fibrosis. METHODS: Stable adult Fontan patients who could safely be examined with magnetic resonance imaging were enrolled, and blood biomarkers, transient elastography were also examined. RESULTS: Forty-six patients received diffusion-weighted imaging; and 58.7% were diagnosed with advanced liver fibrosis (severe liver fibrosis, 37.0%, and cirrhosis 21.7%). Two parameters of hepatic dysfunction, platelet counts (Spearman’s ρ: –0.456, P = 0.001) and cholesterol levels (Spearman’s ρ: –0.383, P = 0.009), decreased with increasing severity of fibrosis. Using transient elastography, a cut-off value of 14.2 kPa predicted the presence of advanced liver fibrosis, but with a low positive predictive value. When we included platelet count, cholesterol, post-Fontan years and transient elastography values as a composite, the capability of predicting advanced liver fibrosis was the most satisfactory (C statistic 0.817 ± 0.071, P < 0.001). A cut-off value of 5.0 revealed a sensitivity of 78% and a specificity of 82%. CONCLUSIONS: In Fontan patients, diffusion-weighted imaging was helpful in detecting liver fibrosis that was correlated with hepatic dysfunction. A simple score was proposed for long-term surveillance and early detection of advanced liver disease in adult Fontan patients. For adult Fontan patients with a calculated score > 5.0, we may consider timely diffusion-weight imaging and early management for liver complications.

Aims: Enhancing life satisfaction is vital for adults with congenital heart disease (ACHD). Life satisfaction potentially correlates with a health-promoting lifestyle and grit. However, the mediating role of grit—a trait marked by perseverance and long-term goal-oriented passion—between a health-promoting lifestyle and life satisfaction in ACHD remains unverified. This study aimed to examine the relationships between health-promoting lifestyle, grit, and life satisfaction in full-time employed ACHD and to confirm the mediating role of grit. Methods and results: A total of 181 full-time employed ACHD aged 20–59 years with patient-reported New York Heart Association classes I–IV were recruited from two medical centres in northern Taiwan. Participants completed questionnaires, including the short version of the Chinese Health-Promoting Lifestyle Profile Scale, Grit-10 Scale, and Satisfaction with Life Scale between February and December 2022. Data analysis employed the Hayes PROCESS macro. Health-promoting lifestyle, grit, and life satisfaction were discovered to be positively correlated. Overall grit score was a partial mediator between a health-promoting lifestyle and life satisfaction, accounting for 20% of the total variation. Of the grit domains, perseverance served as a partial mediator between a health-promoting lifestyle and life satisfaction, accounting for 32% of the total variation, whereas passion had a nonsignificant mediation effect. Conclusion: A health-promoting lifestyle boosts ACHD individuals’ life satisfaction through grit, particularly perseverance. Integrating grit into such a lifestyle could benefit from comprehending support systems and influential factors aiding grit development for enhanced life satisfaction.