2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Stout, Karen; Daniels, Curt J.; Aboulhosn, Jamil; Bozkurt, Biykem; Broberg, Craig S.; Colman, Jack M.; Crumb, Stephen R.; Dearani, Joseph A.; Fuller, Stephanie; Gurvitz, Michelle; Khairy, Paul; Landzberg, Michael J.; Saïdi, A.; Valente, Anne Marie; Hare, George F. Van

doi:10.1161/cir.0000000000000602

Cited by 393 publications

(555 citation statements)

References 420 publications

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“…To help address the problems of ACHD‐trained physician scarcity and the simultaneous increase in the volume of ACHD patients, the American College of Cardiology (ACC) and the American Heart Association (AHA), in their 2008 and 2018 ACHD management guidelines, recommended two tiers of cardiac care follow‐up at an ACHD regional center. First, ACHD patients with simple disease should follow up at least once to establish future need for follow‐up; and second, those with moderate and complex CHD should follow up at least every 12‐24 months . The ACC and AHA list extensive criteria defining the resources which should be available at an ACHD regional center including 24/7 access to ACHD specialists, congenital heart surgeons, and cardiac anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, other CHD subspecialties (interventional cardiology, electrophysiology, advanced heart failure, etc. ), all imaging and diagnostic modalities, and support staff including social work should be readily accessible . While no comprehensive list of centers fulfilling these criteria exists, the Adult Congenital Heart Association (ACHA)—an organization originally founded as a patient advocacy group—began offering comprehensive ACHD center accreditation in 2017 using a similar list of criteria.…”

Section: Introductionmentioning

confidence: 99%

“…and second, those with moderate and complex CHD should follow up at least every 12-24 months. 6,7 The ACC and AHA list extensive criteria defining the resources which should be available at an ACHD regional center including 24/7 access to ACHD specialists, congenital heart surgeons, and cardiac anesthesiologists. Additionally, other CHD subspecialties (interventional cardiology, electrophysiology, advanced heart failure, etc.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

Salciccioli

Oluyomi

Lupo

et al. 2019

Congenital Heart Disease

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Background Follow‐up at a regional adult congenital heart disease (ACHD) center is recommended for all ACHD patients at least once per the 2018 ACC/AHA guidelines. Other specialties have demonstrated poorer follow‐up and outcomes correlating with increased distance from health care providers, but driving time to regional ACHD centers has not been examined in the US population. Objective To identify and characterize potential disparities in access to ACHD care in the US based on drive time to ACHD centers and compounding sociodemographic factors. Methods Mid‐ to high‐volume ACHD centers with ≥500 outpatient ACHD visits and ≥20 ACHD surgeries annually were included based on self‐reported, public data. Geographic Information System mapping was used to delineate drive times to ACHD centers. Sociodemographic data from the 2012‐2016 American Community Survey (US Census) and the Environmental Systems Research Institute were analyzed based on drive time to nearest ACHD center. Previously established CHD prevalence estimates were used to estimate the similarly located US ACHD population. Results Nearly half of the continental US population (45.1%) lives >1 hour drive to an ACHD center. Overall, 39.7% live 1‐4 hours away, 3.4% live 4‐6 hours away, and 2.0% live >6 hours away. Hispanics were disproportionately likely to live a >6 hour drive to a center (p < .001). Compared to people with <1 hour drive, those living >6 hours away have higher proportions of uninsured adults (29% vs. 18%; p < .001), households below the federal poverty level (19% vs. 13%; p < .001), and adults with less than college education (18% vs. 12%; p < .001). Conclusions We estimate that ~45% of the continental US population lives >1 hour to an ACHD center, with 5.4% living >4 hours away. Compounding barriers exist for Hispanic, uninsured, lower socioeconomic status, and less‐educated patients. These results may help drive future policy changes to improve access to ACHD care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

Salciccioli

Oluyomi

Lupo

et al. 2019

Congenital Heart Disease

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“…Similarly, recommendations from the 32nd Bethesda conference in 2000 emphasized the importance of strategic plans to deliver optimal care to the ACHD population . The updated ACC/AHA ACHD Guidelines published by Stout et al in September 2018 suggest that those patients with moderate to complex CHD should be seen by an ACHD specialist no less frequently than annually …”

Section: Introductionmentioning

confidence: 99%

Do we have the ACHD physician resources we need to care for the burgeoning ACHD population?

Ezzeddine

Moe

Ephrem

et al. 2019

Congenital Heart Disease

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Background Delivery of care to the adult congenital heart disease (ACHD) population has been limited by a shortage in the ACHD physician resources. There is limited data regarding the adequacy of the ACHD physician resources in the United States and our population estimates are extrapolated from Canadian data. Therefore, we proposed to evaluate the adequacy of ACHD physician: patient ratios in the United States at both national and regional levels. Methods Data from the Adult Congenital Heart Association (ACHA) website along with metropolitan area and statewide population data from 2016 US Census Bureau estimates were analyzed. Physicians listed on the ACHA website were cross‐referenced with ABIM to verify ACHD board certification status. Results There are 115 self‐identified ACHD programs and 418 self‐identified ACHD physicians listed in the ACHA website. There are 320 board‐certified ACHD cardiologists in the United States today, including 161 not listed in the ACHA website. Regarding ratios of ACHD‐certified physicians to patients, the best served metropolitan statistical area (MSA) is Raleigh‐Cary, NC, and the worst served MSA is Riverside‐San Bernardino‐Ontario, CA. The best served State is Washington, DC, and the worst served State is Indiana. Conclusions The ACHD population continues to grow, and the looming national physician shortage is likely to greatly affect the ability to meet the complex needs of this growing population. In order to bring the ACHD patient: physician ratio to 1000:1, a minimum of 170 additional ACHD board‐certified physicians are needed now.

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“…In particular, studies targeting regions of latest activation have yielded favorable outcomes . Recently, the role of CRT in patients with systemic RV anatomy has been identified as a major research priority by expert consensus opinion …”

Section: Introductionmentioning

confidence: 99%

A minimally invasive hybrid approach for cardiac resynchronization of the systemic right ventricle

Moore

Gallotti

Shannon

et al. 2018

Pacing Clinical Electrophis

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Background Patients with systemic right ventricle (RV) often develop progressive heart failure and may benefit from cardiac resynchronization therapy (CRT); however, the optimal strategy for CRT has not been defined. Methods A retrospective review of all the patients with systemic RV failure undergoing a hybrid transcatheter‐surgical approach was performed. Procedural technique and outcomes are reported. Results Six patients underwent detailed electroanatomical mapping of the systemic RV followed by a new hybrid approach targeting latest endocardial activation, which was followed by focused epicardial mapping. The exact site of latest endocardial activation was variable but localized to the basolateral RV in all cases. Sites of latest activation tended to be more superior during contralateral ventricular pacing versus intact atrioventricular conduction (P = 0.06). Latest endocardial activation at the targeted site occurred at 157 ms (interquartile range [IQR] = 120‐181 ms) and corresponding epicardial activation at 174 ms (IQR = 140‐198 ms), after the onset of the QRS complex. Following the hybrid CRT, the QRS duration decreased from a median of 193 to 147 ms and the fractional area of change increased from a median of 15.5% to 30% (P < 0.001). Patients were discharged to home after a median of 4 days. Of the three patients who were initially referred for transplant evaluation, two (66%) of them no longer met the criteria following CRT. Conclusions Whereas latest endocardial activation for the systemic RV appears to localize to the basolateral region, the optimal lead position may be variable. An approach utilizing endocardial mapping followed by a limited surgical incision and confirmation of latest activation may result in minimally invasive surgery and a favorable acute CRT response.

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2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Cited by 393 publications

References 420 publications

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

Do we have the ACHD physician resources we need to care for the burgeoning ACHD population?

A minimally invasive hybrid approach for cardiac resynchronization of the systemic right ventricle

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