Adult congenital heart care in the COVID-19 era, and beyond: A call for action

Abstract

While virus epidemics are nothing new to man, the scale, speed of global spread and immediacy of the COVID-19 pandemic have been truly unprecedented [ 1 ]. The entire world has been turned on its head in less than a few months, with major implications beyond disease burden and loss of life, threatening the economic status quo and human psychosocial balance and wellbeing not only for patients, but for all of us. The primary aim of our Call for Action Viewpoint was to support and protect our adult congenital heart disease (ACHD) patients and their needs during these challenging and uncertain times. This goal had to be met while we, as individuals, teams, institutions and nations, came together in a global effort to combat this aggressive virus, that appears to spare no organs or systems, nor any borders, geographic or other. As with any crisis, there is always opportunity: we are submitting herewith a vision for a different and better model of ACHD care, and for a better life journey and health care experience for our patients, that should be in place in the aftermath of the Covid-19 pandemic. Many of the points and principles discussed in this article, need not be confined to ACHD patients, but have a broader reach. And we must not forget nor neglect the most vulnerable in society at this time, namely the elderly, disabled and other dependent or disadvantaged groups in this “We Are One” global operation. Last but not least, this maybe the time to take better care of ourselves (and others) and reflect on life .

The spectrum of COVID-19 in complex adult congenital heart disease: A case series

“…Vaccines offer hope, however the limited availability of data hinders specific recommendations. In other respects, ACHD patients should maintain a healthy, active lifestyle, maintain social distancing and utilize technology to preserve continuity of care 9 , 10 .…”

Atherosclerosis in Congenital Heart Disease

“…A healthy lifestyle should be pursued in all ACHD patients, while counseling to encourage daily participation in physical activity and aerobic exercise or cardiac rehabilitation programs (according to functional capacity) should become an essential part of follow-up visits at congenital cardiologist’s offices. 9 , 10 Smoking cessation and adherence to a dietary pattern including reduced calories in saturated and transfatty acids and lower sodium intake should be discussed. Screening for and modifying ASCVD risk factors earlier in life might further improve patient outcomes; hence, pediatric cardiologists also have a crucial role to play in preventive cardiology counseling in children/adolescents with CHD.…”

Adult Congenital Heart Disease

“…Ongoing research and growing understanding of the late pathophysiology of CHD are continuously refining all aspects of care for these patients. Putting the patient in the very center of these efforts further advances the existing model of care ( 3 ). A personalized patient path should be the way forward, starting from prenatal diagnosis and planning, through childhood, and with a seamless transition to adult care with a lifelong trajectory ( Figure 1 ).…”

“…A personalized patient path should be the way forward, starting from prenatal diagnosis and planning, through childhood, and with a seamless transition to adult care with a lifelong trajectory ( Figure 1 ). We have proposed that patient-centered adult CHD care should include a single-day assessment at the CHD center for all patients, including those transitioned from pediatric care, where a comprehensive and thorough assessment takes place, including imaging, cardiopulmonary exercise testing (or 6-min walk distance), biomarkers, genetics, and consultation with the adult CHD Consultant and Clinical Nurse Specialist ( 1 , 3 ). At this crucial visit, patients should be risk-stratified and receive all necessary information about their condition, prognosis, lifestyle, family planning and contraception, what to do with emergencies, etc.…”