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Resilience in children with congenital heart disease: a comparative study with health counterparts
  1. Katharina Köble1,
  2. Laura Willinger1,2,
  3. Leon Brudy2,
  4. Renate Oberhoffer-Fritz1,2,
  5. Peter Ewert2,3,
  6. Jan Müller1,2
  1. 1Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
  2. 2Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, Munich, Germany
  3. 3partner site Munich Heart Alliance, German Centre for Cardiovascular Research, Munich, Germany
  1. Correspondence to Katharina Köble, Institute of Preventive Pediatrics, Technical University of Munich, Munich, 80992, Germany; katharina.koeble{at}


Objective Resilience is a complex, yet rather unexplored topic in patients with congenital heart disease (CHD). The goal of this study was to assess and compare resilience in children with CHD with healthy controls during the COVID-19 pandemic.

Design and patients From June 2020 to June 2021, 124 children with various CHDs (14.6±2.1 years, 49 girls) and 124 matched healthy controls (14.8±2.0 years, 49 girls) completed the Resilience Scale-11 short version.

Results Resilience was significantly reduced in children with CHD compared with healthy controls (CHD: 59.0±10.0 vs healthy controls: 64.4±6.5, p<0.001). That reduction was prominent in all CHD subgroups except those with left heart obstruction (aortic stenosis and coarctation of the aorta) and patients with transposition of the great arteries. Complex CHD had the lowest resilience of 57.6±8.4 (p<0.001) after adjusting for age and sex according to group differences. There was no difference between native CHD and CHD with open-heart surgery (native: 59.5±12.2 vs surgery: 58.8±9.3, p=0.758).

Conclusions Resilience was reduced in children and adolescents with CHD compared with healthy peers during the COVID-19 pandemic. Children with complex severity appeared to be particularly affected. These findings emphasise continued efforts to provide a holistic and multidisciplinary approach in medical aftercare of these patients and their families.

  • Mental health
  • Covid-19
  • Cardiology
  • Psychology

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

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  • KK and LW contributed equally.

  • Collaborators Shared authorship with author no 2 Laura Willinger.

  • Contributors JM was responsible for conception and design of the study and for data monitoring and integrity and was the guarantor of this study. KK, LB and LW sampled the data. KK, LW and JM analysed the data and drafted the manuscript. RO and PE supported in acquisition of the patients, and gave important input for revising and improving the quality of the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This study was funded by an unrestricted grant from ‘Fördergemeinschaft Deutsche Kinderherzzentren e.V.’.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.