{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:23Z","timestamp":1787721623473,"version":"build-2784847793"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Physical activity is essential for reducing cardiovascular risk in children with congenital heart disease (CHD). However, evidence of this association in early childhood remains limited. This study aimed to examine the association between physical activity and health care use and burden in preschool\u2010aged children with CHD using a nationwide, population\u2010based cohort in Korea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed data from 44\u2009349 children born between 2014 and 2016 who were diagnosed with CHD and enrolled in the National Health Insurance Service database. Participants were categorized as physically active or inactive based on their responses to a national infant health screening questionnaire. Health care use, including hospitalizations, intensive care unit days, tertiary hospital and emergency department visits, and total medical costs, was assessed over a 3\u2010year follow\u2010up period. Adjustments were made for CHD severity and surgical complexity using American Heart Association and Risk Adjustment for Congenital Heart Surgery\u20102. Stabilized inverse probability of treatment weighting was applied to ensure robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Physical inactivity was significantly associated with a higher risk of hospitalization, increased tertiary outpatient visits, and longer intensive care unit stays. Although no overall association was observed with emergency department visits or total medical costs in the overall cohort, significant effect modification by CHD severity was identified. These increased risks were specifically observed in children with moderate\u2010to\u2010severe CHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Active participation in physical activities during preschool years was associated with reduced health care use among children with CHD, supporting the need for early, individualized physical activity guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047834","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:17:34Z","timestamp":1783073854000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Preschool Physical Activity and Health Care Use and Burden in Children With Congenital Heart Disease"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1156-6536","authenticated-orcid":false,"given":"Chang Sin","family":"Kim","sequence":"first","affiliation":[{"name":"Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5011-5557","authenticated-orcid":false,"given":"Minkyung","family":"Han","sequence":"additional","affiliation":[{"name":"Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Yonsei University","place":["Seoul, Republic of Korea"]},{"name":"Harvard T.H. Chan School of Public Health","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7153-4937","authenticated-orcid":false,"given":"Dong\u2010wook","family":"Rha","sequence":"additional","affiliation":[{"name":"Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3780-3213","authenticated-orcid":false,"given":"Inkyung","family":"Jung","sequence":"additional","affiliation":[{"name":"Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-4137","authenticated-orcid":false,"given":"Juntaek","family":"Hong","sequence":"additional","affiliation":[{"name":"Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.08.025"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.179568"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2004.12.003"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(19)30323-2"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/1741826711420000"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004665"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2023.105870"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318293688f"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.00170"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1123\/apaq.25.1.49"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychsport.2011.07.001"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2006.105239"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp305"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3435"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011858"},{"key":"e_1_3_2_17_2","unstructured":"National Health Insurance Medical Benefit Costs (January 2024 Edition). 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