Guideline updated for treating adult patients with congenital heart disease
An updated guideline retains the original's classification of adult congenital heart disease patients based on structural complexity of the disease but takes into account patients' functional status and other factors, including the presence of cardiovascular and noncardiovascular problems.
The American College of Cardiology and the American Heart Association recently updated their guideline for patients with adult congenital heart disease (ACHD).
ACHD patients are a small population, but a growing one given their 90% survival rate, according to the guideline. “Almost all patients with ACHD will have sequelae of either their native CHD or its surgical repair or palliation, although these sequelae can take decades to manifest,” it stated.
The 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease, a full revision of the original 2008 guideline, incorporates new data and expertise and was published online Aug. 16 by the Journal of the American College of Cardiology and Circulation.
The guideline retains the original's classification based on structural complexity of the disease but takes into account patients' functional status and other factors, including the presence of cardiovascular and noncardiovascular problems. It addresses the complexity of ACHD patients in terms of both anatomy and physiology rather than anatomy alone.
Issues addressed by the guideline include mental health and neurodevelopmental issues, exercise and sports, noncardiac medical issues, and pregnancy. Dozens of specific conditions and procedures are discussed, including lesion-specific recommendations for interval clinical follow-up and tests such as electrocardiography, transthoracic echocardiography, and exercise testing.
There is a growing body of high-quality data about ACHD, but it should be interpreted cautiously, according to the guideline. “The heterogeneity of the population and the long, symptom-free intervals constrain the ability to generate data applicable across the population of ACHD or to adults with specific lesions or repairs,” it said.
Patients with significant conditions who are cared for in specialty centers have better outcomes than those cared for in centers without such expertise, and the need for specialized care is noted throughout the guideline. Diagnosis and management may require cardiac anesthesiologists, electrophysiologists, and interventional cardiologists; imaging services such as cardiac MRI and CT; and pulmonary hypertension services with expertise in ACHD, the guideline stated.
The recommendations are intended to provide guidance to a wide variety of clinicians caring for patients with ACHD, including general, pediatric, and ACHD cardiologists, surgeons, and primary care physicians.