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Frank LH, Glickstein J, Brown DW, Mink RB, Ross RD. Child Health Needs and the Pediatric Cardiology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678E. [PMID: 38300014 PMCID: PMC10852197 DOI: 10.1542/peds.2023-063678e] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article evaluates the pediatric cardiology (PC) workforce and forecasts its future supply. Produced as part of a supplement in Pediatrics, this effort represents a collaboration among the American Board of Pediatrics Foundation, the University of North Carolina at Chapel Hill's Carolina Health Workforce Research Center, the Strategic Modeling and Analysis Ltd., and members of the pediatric subspecialty community. PC is a complex subspecialty including care from fetal life through adulthood and in practice settings that range from the outpatient clinic to procedural settings to the cardiac ICU. Complex subdisciplines include imaging, electrophysiology, heart failure, and interventional and critical care. Using American Board of Pediatrics data, US Census Bureau data, and data from the modeling project, projections were created to model the subspecialty workforce through 2040. Across all modeling scenarios considered, there is considerable projected growth in the supply of pediatric cardiologists by 2040. However, there is significant regional variation in the projected supply of trainees relative to demand in terms of local population growth, with evidence of a likely mismatch between areas surrounding training centers versus areas of greatest workforce need. In addition, this article highlights areas for future focus, including efforts to attract more residents to the subspecialty in general, particularly underrepresented minority members; increased support, more part-time career options, and improved academic career advancement for women in PC; and the development of better "real-time" workforce data to guide trainees and training programs in decisions regarding sub-subspecialty job availability.
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Affiliation(s)
- Lowell H. Frank
- Division of Cardiology, Children’s National Hospital, Washington, District of Columbia
| | - Julie Glickstein
- Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, New York
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Richard B. Mink
- David Geffen School of Medicine at the University of California Los Angeles, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, Torrance
| | - Robert D. Ross
- Division of Cardiology, Children’s Hospital of Michigan, Detroit, Michigan
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2
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McMahon CJ, Voges I, Jenkins P, Brida M, van der Bosch AE, Dellborg M, Heying R, Stein JI, Georgiev B, Mesihovic-Dinarevic S, Prokšelj K, Oskarsson G, Frogoudaki A, Karagöz T, Jossif A, Doros G, Nielsen D, Jalanko M, Sanchez Perez I, Alvares S, Estensen ME, Petropoulos A, Tagen R, Gumbienė L, Michel-Behnke I, Olejnik P, Clift PF, Sendzikaite S, Albert-Brotons DC, Rhodes M, Pitkänen O, Bassareo PP, Gatzoulis MA, Walsh K, Milanesi O, Ladouceur M, Chessa M, Budts W. Adult congenital heart disease training in Europe: current status, disparities and potential solutions. Open Heart 2023; 10:e002558. [PMID: 38097363 PMCID: PMC10729203 DOI: 10.1136/openhrt-2023-002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe. METHODS A questionnaire was sent to ACHD cardiologists from 34 European countries. RESULTS Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001). CONCLUSION Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.
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Affiliation(s)
- Colin J McMahon
- Children's Health Ireland at Crumlin, Crumlin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
| | | | - Petra Jenkins
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- Medical Rehabilitation, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | | | - Mikael Dellborg
- Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ruth Heying
- Department Paediatric Cardiology Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Jörg I Stein
- Department of Paediatric Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Katja Prokšelj
- Department of cardiology, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | - Tevfik Karagöz
- Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children's Hospital, Ankara, Turkey
| | - Antonis Jossif
- Paedi Center for Specialized Pediatrics, Strovolos, Cyprus
| | - Gabriela Doros
- Paediatric Cardiology, Louis Turcanu Emergency Children Hospital, Timisoara, Romania
| | - Dorte Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikko Jalanko
- Heart and Lung Centre, HYKS sairaanhoitopiiri, Helsinki, Finland
| | | | - Sílvia Alvares
- Pediatric Cardiology Department, Oporto Medical Center, Porto, Portugal
| | | | - Andreas Petropoulos
- Ped.Cardiology, Merkezi klinika, Baku, Azerbaijan
- Pediatrics, Azerbaycan Tibb Universiteti Nariman Narimanov, Baku, Azerbaijan
| | - Raili Tagen
- Department of Cardiac Surgery, Tartu University Hospital, Tartu, Estonia
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Vilniaus universitetas Medicinos fakultetas, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilniaus Universiteto ligonines Santariskiu klinikos, Vilnius, Lithuania
| | - Ina Michel-Behnke
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Olejnik
- Department of Pediatric Cardiology, Comenius University, Bratislava, Slovakia
| | - Paul F Clift
- Grown Up Congenital Heart Disease Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Olli Pitkänen
- Divisions of Pediatric Cardiology, Children's Hospital/Helsinki University Hospital, Helsinki, Finland
| | | | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Kevin Walsh
- Heart House, Mater Misericordiae Hospital, Dublin, Ireland
| | | | - Magalie Ladouceur
- Cardiology, Hopital Europeen Georges Pompidou, Paris, France
- Pediatric Cardiology, Hopital universitaire Necker-Enfants malades, Paris, France
| | - Massimo Chessa
- Pediatric Cardiology Department and GUCH Unit, Policlinico San Donato, San Donato Milanese, Italy
| | - Werner Budts
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
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Keir M, Tarr C, McFadden C, Durupt G, Newman L, Balon Y, Prieur T, Patton DJ, Jenkins J, Alvarez N, Colbert J, Guron N, Reynolds S, Myers K. Determining Research Priorities With Teen and Adult Congenital Heart Disease Patients: A Mixed-Methods Study. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:74-81. [PMID: 37970526 PMCID: PMC10642133 DOI: 10.1016/j.cjcpc.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 11/17/2023]
Abstract
Background Children with congenital heart disease (CHD) are living longer than ever before. This growing cohort of adults with CHD has high medical and psychosocial needs. Also, patients and advocacy groups are justifiably demanding that their voices be heard in all phases of clinical and health services research. Methods We conducted a first of its kind research priority-setting exercise with teens and adults with moderate-to-complex CHD. Focus groups were held using a fixed, mixed methods, exploratory sequential design. Objectives were to include the patient voice in all phases of the research process, determine the key needs of patients living with CHD, to guide health services research, and identify the "top 10" research priorities of teens and adults living with CHD. Results Thirty-five patients participated in one of nine 3-hour focus groups where they shared their experiences living with CHD. They expressed a desire for connection with others living with CHD and altruistic motives for participating. Patients with CHD identified a need for information about their disease and prognosis, a need for connection through physical activity and mentorship programmes, and a need for advanced communication with health care teams. Qualitative results correlated well with quantitative ratings to create a patient-derived "top 10" research priorities list. Conclusions Patients affected by a chronic disease like CHD want to be included in all phases of research. Our research priority-setting exercise in teens and adults with CHD has created a roadmap for clinicians and researchers to investigate issues most important to those living with CHD.
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Affiliation(s)
- Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Tarr
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Chanda McFadden
- Department of Allied Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Glenda Durupt
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lori Newman
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yvonne Balon
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Timothy Prieur
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - David J. Patton
- Section of Pediatric Cardiology, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Jenkins
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nanette Alvarez
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jillian Colbert
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Namrata Guron
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Stephen Reynolds
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kim Myers
- Section of Pediatric Cardiology, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
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Keir M, Borman M, Clegg R, Colbert J, Guron N, Harper L, Helmerson D, Patzer J, Reynolds S, Alvarez N. Caring for the Aging Patient With Adult Congenital Heart Disease: A Review of Cardiac and Noncardiac Comorbidities. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:274-281. [PMID: 37969485 PMCID: PMC10642149 DOI: 10.1016/j.cjcpc.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2023]
Abstract
As the demographics of congenital heart disease (CHD) have shifted, there are now more adults living with CHD than children in North America. This presents unprecedented challenges as patients with CHD acquire noncardiac comorbidities and seek care for a variety of reasons, including noncardiac surgery and emergency department (ED) visits. CHD shifts from a one organ problem to a multisystem disease and requires a team of specialists to maintain high-quality longitudinal care. In this review, we summarize the challenges patients with CHD and their providers face as they age. We review the demographics of CHD and health care utilization. We examine the rates of noncardiac comorbidities and the current quality of care received by adult patients with CHD.
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Affiliation(s)
- Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Meredith Borman
- Section of Gastroenterology, Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robin Clegg
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jillian Colbert
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nita Guron
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lea Harper
- Section of Respirology, Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doug Helmerson
- Section of Respirology, Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Patzer
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Stephen Reynolds
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nanette Alvarez
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Sparking the Fire in Adult Congenital Heart Disease. J Am Coll Cardiol 2022; 80:641-645. [PMID: 35926938 DOI: 10.1016/j.jacc.2022.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
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Lopez KN, Baker-Smith C, Flores G, Gurvitz M, Karamlou T, Nunez Gallegos F, Pasquali S, Patel A, Peterson JK, Salemi JL, Yancy C, Peyvandi S. Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025358. [PMID: 35389228 PMCID: PMC9238447 DOI: 10.1161/jaha.122.025358] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the overall improvement in life expectancy of patients living with congenital heart disease (congenital HD), disparities in morbidity and mortality remain throughout the lifespan. Longstanding systemic inequities, disparities in the social determinants of health, and the inability to obtain quality lifelong care contribute to poorer outcomes. To work toward health equity in populations with congenital HD, we must recognize the existence and strategize the elimination of inequities in overall congenital HD morbidity and mortality, disparate health care access, and overall quality of health services in the context of varying social determinants of health, systemic inequities, and structural racism. This requires critically examining multilevel contributions that continue to facilitate health inequities in the natural history and consequences of congenital HD. In this scientific statement, we focus on population, systemic, institutional, and individual‐level contributions to health inequities from prenatal to adult congenital HD care. We review opportunities and strategies for improvement in lifelong congenital HD care based on current public health and scientific evidence, surgical data, experiences from other patient populations, and recognition of implicit bias and microaggressions. Furthermore, we review directions and goals for both quantitative and qualitative research approaches to understanding and mitigating health inequities in congenital HD care. Finally, we assess ways to improve the diversity of the congenital HD workforce as well as ethical guidance on addressing social determinants of health in the context of clinical care and research.
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Neurocognition in Adult Congenital Heart Disease: How to Monitor and Prevent Progressive Decline. Can J Cardiol 2019; 35:1675-1685. [DOI: 10.1016/j.cjca.2019.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
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Marckini DN, Samuel BP, Parker JL, Cook SC. Electronic health record associated stress: A survey study of adult congenital heart disease specialists. CONGENIT HEART DIS 2019; 14:356-361. [PMID: 30825270 DOI: 10.1111/chd.12745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physician burnout has many undesirable consequences, including negative impact on patient care delivery and physician career satisfaction. Electronic health records (EHRs) may exacerbate burnout by increasing physician workload. OBJECTIVE To determine burnout in adult congenital heart disease (ACHD) specialists by assessing stress associated with EHRs. DESIGN Electronic survey study of ACHD providers. SETTING Canada and United States. PARTICIPANTS Three hundred eighty-three ACHD specialists listed on the Adult Congenital Heart Association directory between February and April 2017. OUTCOME MEASURES Burnout was measured using the Maslach Burnout Inventory (MBI) to understand factors contributing to work life and EHR satisfaction. Chi-square and Wilcoxon Rank Sum tests were used for statistical analysis. RESULTS Of the 383 invited participants, 110 (28.7%) completed surveys with the majority (n = 88, 80.7%) reporting from an academic medical center. Burnout was defined as high scores on the emotional exhaustion and/or depersonalization MBI subscales. When comparing the 40% (n = 44) that met criteria for burnout with those that did not, there was strong disagreement that a reasonable amount of time is spent on clerical tasks related to direct (P = .0043) or indirect (P = .0004) patient care. There was strong disagreement that EHRs increased efficiency (P = .006) or the patient portal improved patient care (P = .0215). Finally, physicians who met criteria for burnout had lower personal accomplishment scores (P = .0355). CONCLUSIONS Our results suggest time spent on EHRs creates clerical burden exacerbating ACHD physician burnout. The high levels of emotional exhaustion may decrease quality of ACHD care by directing focus away from physician-patient interaction. Health care systems must develop best practice for EHR design and implementation to optimize patient advocacy and care, and decrease physician burnout.
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Affiliation(s)
- Darcy N Marckini
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Bennett P Samuel
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | | | - Stephen C Cook
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan.,College of Human Medicine, Michigan State University, Grand Rapids, Michigan
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Ephrem G, Alshawabkeh L. Contemporary ACHD training and the reality of the field in the United States. Int J Cardiol 2019; 277:85-89. [DOI: 10.1016/j.ijcard.2018.08.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/24/2018] [Indexed: 11/26/2022]
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Araujo JJ. Adults with congenital heart disease: A growing public health problem? ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:251-252. [DOI: 10.1016/j.acmx.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022] Open
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Abstract
PURPOSE OF REVIEW At present, 85-90% of those born with congenital heart disease (CHD) grow up to become adults. With few exceptions, reparative surgery is not curative and requires long-term surveillance. Caregivers could be changed from pediatric cardiologists to adult CHD specialists (or cardiologists) during this process. This study will focus on the current practice of transition in CHD. RECENT FINDINGS Residua and sequelae may progress in severity with age and induce late complications, such as arrhythmias, cardiac failure, thromboembolism, sudden cardiac death, reoperation, cardiac intervention, and arrhythmia ablation. There are other obstacles that further complicate adult CHD, including pregnancy and delivery, noncardiac surgery, psychosocial problems, health insurance coverage, and extracardiac complications, making close follow-up and proper management mandatory. Because of this, several specialized centers have been established to respond to this need, and several studies focusing on transition have been published recently. SUMMARY Provision of comprehensive care by multidisciplinary teams including adult CHD specialists, adult and pediatric cardiologists and cardiovascular surgeons, specialized nurses, and other specific disciplines are the fundamental features in care facilities for adult CHD. Training and education should be focused on adult CHD fellows who represent the next generation that will assume responsibility for this patient population. Proper transition from pediatric cardiologists and cardiovascular surgeons to adult CHD care team, including adult CHD specialists and/or cardiologists trained in this field, is mandatory.
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