"Blatant nursing shortage in pediatric cardiac medicine" - Interview with Prof. Oberhoffer-Fritz and Prof. Ewert on the occasion of the Day of the Child with Heart Disease

The Day of the Child with Heart Disease, which takes place annually on May 5, was established in 1994 by the German Heart Disease Association (Bundesverband Herzkranke Kinder e.V.) to draw attention to the problems and needs of children with heart disease as well as medical developments, and to provide information about therapeutic options. In this double interview, Prof. Dr. med. Renate Oberhoffer-Fritz, Dean of the Department of Sport and Health Sciences and head of the Chair of Preventive Pediatrics, and Prof. Dr. med. Peter Ewert, Director of the Department of Paediatric Cardiology and Congenital Heart Defects and Deputy Medical Director of the German Heart Centre Munich, talk about joint cooperation, the importance of scientific interdisciplinarity, and the effects of the COVID-19 pandemic on children with heart disease.

Let's start with two pressing questions. Do you think it makes sense to vaccinate children and especially children with heart disease against COVID-19?

Prof. Ewert: "It would be good if children were vaccinated so that they themselves are protected, but above all so that they do not infect others. Vaccines for children will probably be approved by the end of the year. Fortunately, there's little need to prioritize heart children."

Has the COVID-19 pandemic had an impact on early detection and treatment of heart disease in children?

Prof. Oberhoffer-Fritz: "So far, little is known about secondary diseases in children tested positive, in the sense of 'Long COVID'. However, we want to set up a study to follow up the children cardiovascularly. This also applies in particular to adolescent junior athletes, whom we examine in our joint sports cardiology outpatient clinic. Here there are some who were ill and now want to train again, but then find that they have had a drop in performance. For this, we are currently in the conception and application phase in close coordination with the Bavarian State Ministry of Health."

Prof. Ewert: "In cardiology, there is discussion that adults go to the doctor less often because of the pandemic and thus suffer heart attacks more often. Fortunately, we cannot determine this for children. However, the pandemic restrictions are endangering children's health, there is a lack of exercise, and there is a lack of social exchange. For example, there are studies that show that ADHD has increased by more than 70 percent in children. But there are also positive side effects. For example, some neonatologists claim to have found that fewer premature babies are being born because mothers aren't on the go as much and are home more."

We celebrate the Day of the Child with Heart Disease on May 5. How important is that to your work?

Prof. Ewert: "Congenital heart defects are the most common anomaly in childhood. About one percent of all children are affected. Fortunately, most of them have only a mild heart defect, but many will still need medical treatment for the rest of their lives. Children with heart disease have a handicap, which the day points out. But of course we also want to highlight the successes that have been achieved in cardiac medicine specifically for children with congenital heart defects in recent decades. The well-known German psychiatrist Klaus Dörner once said: 'A successful life also requires burden.' Heart children have a certain burden and, as a result, a different approach to life. The Day of the Child with Heart Disease is therefore not only a day for children with heart disease, but can also be a signal of what life is all about and what is really important."

Prof. Oberhoffer-Fritz: "Children with heart disease are less anchored in the public's consciousness than children with cancer, for example. We want to remind that there are people who are handicapped by certain problems throughout their lives. After all, the term heart-diseased child doesn't just mean that they are congenitally heart-diseased, but that children can also become heart-diseased in the course of their lives, for example due to an unhealthy lifestyle or after they have had certain other illnesses."

Prof. Ewert: "The Day of the Child with Heart Disease is also intended to draw attention to the situation of children with heart disease and their care. The most crucial course for these children is set in infancy. If they are cared for sensibly there, then a fully integrated life into old adulthood is possible. At the moment, this is on the back burner, because the care crisis in Germany is primarily concerned with care for the elderly. It is too often and quickly forgotten that in this special area of pediatric cardiac medicine there is also a blatant nursing emergency. The children who have life-defining heart surgeries, especially in the early stages, have a certain shortage of care because we don't have enough nurses."

How many children with heart disease are you currently treating?

Prof. Ewert: "It is estimated that 6,000 children with congenital heart defects are born in Germany every year. We at the Heart Centre perform about 500 heart operations and 800 catheter examinations per year. Of the most severe heart defects, the so-called univentricular hearts, when someone has only half a heart, only 200 children are born each year in Germany. But these children in particular have very high needs over the course of their entire lives, both in terms of medical care and general support."

How did the cooperation between the Chair of Preventive Pediatrics and the German Heart Centre Munich come about?

Prof. Oberhoffer-Fritz: "I am a pediatric cardiologist by training and moved from the German Heart Centre Munich to the Department of Sport and Health Sciences in 2007 with the idea of preventing acquired cardiovascular diseases as early as possible and maintaining the connection to the German Heart Centre Munich. The cardiovascular system and sports science are very closely related, in terms of cardiovascular performance, the important issues of exercise."

Prof. Ewert: "And the cooperation has two aspects. On the one hand, children with heart disease also need to be supported in their motor skills. The two departments want to find out how physically resilient these children are and how they can be supported. The second aspect is that today's healthy children are tomorrow's heart patients. Therefore, one of the questions we are addressing is how to establish prevention in childhood so that there is less cardiovascular disease overall in an aging population. Cornerstones to the questions of healthy nutrition and better exercise are laid in childhood."

What in particular distinguishes the cooperation between the Department of Sport and Health Sciences and the German Heart Centre Munich?

Prof. Ewert: "The combination of sports sciences and pediatric cardiac medicine is unique in this form in Germany, perhaps even in Europe, and can look back on a long history of success. Over the years, around 2,000 examinations have been carried out on about 1,000 children with congenital heart defects as part of the cooperation. This has resulted in about 70 scientific publications. What sports science does at the Heart Centre, we cannot do as pediatric cardiologists. And the patients we treat at the Heart Centre are otherwise hardly accessible to sports science."

What is the objective of the joint collaboration?

Prof. Oberhoffer-Fritz: "The focal points of the cooperation are to improve the health of children who already have heart disease and to promote their daily lives through exercise concepts, as well as to prevent cardiovascular disease in sick children."

What projects are being carried out as part of the cooperation?

Prof. Ewert: "For example, we are investigating how capable children with congenital heart defects are. As an example, I would like to mention a male patient who has only 'half a heart' and hiked to the Zugspitze with his father by foot. He lives with a hypoplastic left heart, the most severe heart defect there is, and still manages to climb the highest mountain in Germany. Impressive!"

Prof. Oberhoffer-Fritz: "We not only collect data, but also try to improve cardiovascular and pulmonary function through breathing training, for example. In addition, we offer exercise training, as in the innovative 'Digital Health Nudging' project on web-based training. Here, the intervention group with patients with congenital heart defects is to be encouraged to be physically active over a period of three months using digital text or image messages on their smartphones. Another example is 'Skipping Hearts', a still ongoing project of the German Heart Foundation, which also supports our two departments. It uses modern methods to motivate elementary school students to jump rope, which stimulates the circulation and is also good for coordination and against osteoporosis. TUM carried out the scientific evaluation of this nationwide project."

What role does interdisciplinarity play in your cooperation?

Prof. Ewert: "We are a brilliant example of interdisciplinarity! For me as a physician at the Heart Centre, it is a real gift that we have the sports scientists, because they can do things that we as physicians cannot. In the duality of patient care and research, we essentially deal with the diseases, but not what sports science deals with. So if you need a 'role model' for interdisciplinarity: here's an excellent one."

Prof. Oberhoffer-Fritz: "At the end of the day, our interdisciplinarity has invigorated the professional societies, because these topics were not represented before. For many years, the topics of exercise and sport and their importance for heart health have had their relevance in the German and European professional society of cardiology. Looking to the future, however, there is still a very great need here, especially for children."

Back in 2007, "kidsTUMove" was founded, a model project for all children and adolescents, especially those with chronic diseases such as obesity, high blood pressure, cardiological diseases or oncological diseases. What is the significance of the project for your patients?

Prof. Oberhoffer-Fritz: "kidsTUMove is an example of how we at the university manage to transport knowledge into society. Because we can convey this knowledge to the children and adolescents as well as their families. This translation into society has always been very important to us. In the meantime, we have also linked up with the TUM Family Service with the project in order to get even more children interested in sports and exercise activities as well as healthy nutrition. Over 300 children took part in our virtual Easter camp in the spring. That impressively documents the social importance of such activities."

Thank you very much for the interview!


To the homepage of the Chair of Preventive Pediatrics

To the homepage of the Department of Paediatric Cardiology and Congenital Heart Defects of the German Heart Centre Munich



Prof. Dr. med. Renate Oberhoffer-Fritz
Dean Department of Sport and Health Sciences
Chair of Preventive Pediatrics
Georg-Brauchle Ring 60/62
80992 München

phone: 089 289 24570
e-mail: renate.oberhoffer(at)tum.de

Prof. Dr. med. Peter Ewert
Director, Department of Paediatric Cardiology and Congenital Heart Defects
German Heart Centre Munich
Lazarettstr. 36
80636 München

phone: 089 12183011
e-mail: ewert(at)dhm.mhn.de

Text/Interview: Romy Schwaiger
Photos: Andreas Heddergott/TUM