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Adult congenital heart disease: education, education, education

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 2–3 (2006)Cite this article

Adult patients with congenital heart disease (CHD) are the beneficiaries of successful pediatric cardiac surgery and cardiology programs around the world.1 Over half of them would have died before reaching adulthood had it not been for surgical intervention in infancy and childhood. This success in treatment is exemplified by the fact that 96% of children with CHD who survived infancy will live to at least 15 years of age.2 It has been estimated that there are currently over 250,000 adults with CHD in the UK, approximately 1,000,000 in the US and similar numbers in proportional terms in Europe and the rest of the world.3 The prevalence will continue to grow exponentially as more patients survive early interventions and adult patients with CHD live longer.4,5 Although the outlook for patients with CHD has been transformed, most early interventions have not been curative. It is estimated that approximately 50% of adult patients with CHD face the prospect of further surgery, arrhythmia, heart failure and—if managed inappropriately—of premature death.6 The complexity of the anatomy and physiology, and symptoms, that these patients present in adulthood, often exceed the expertise of physicians who are not trained specifically in CHD, including those with a general cardiovascular background.3,4,6 The increased workload of caring for this group of patients is therefore both quantitative and qualitative.7 In addition, there is a pressing need for research into late pathophysiologic mechanisms in this expanding patient population and into the efficacy of further medical, catheter-based and surgical therapy. This viewpoint argues that education is the key to translating research advances into improved care of adults with CHD, including the large number of adult CHD patients who, sadly, do not receive cardiac follow-up.

We need to reach out and educate a broader professional audience on the principles and challenges regarding the care of the patient with CHD. This broader audience should include general cardiologists and physicians, obstetricians, other hospital specialists, family doctors and health allied professionals.8 While the CHD aficionados will continue to educate themselves using the endless opportunities for continuing medical education, we need to expand our educational portfolio and extend our efforts to reach a wider audience. Although high-level, sophisticated and somewhat esoteric material has been the main academic drive for many individuals or teams working in the field, and remains essential for maintaining and improving tertiary practice, a change in emphasis is required—towards educational efforts at a more-basic level, which are accessible and clear to this broader target audience. Widely available guidelines, more-basic textbooks and more publications in general cardiology and medical journals, are a few tools that could be used to achieve this goal. In other words, we need to highlight the main issues and basic principles of managing adult CHD to a larger professional body. Although desirable, it is not possible to provide comprehensive, total health care for an adult CHD patient in a tertiary center for many reasons, including geography, lack of capacity and need for local emergency care.2,4,7 It is therefore essential that we engage and support this broader professional group in the management of adult CHD patients to achieve the common goal of improved patient care. Furthermore, we need a stronger representation of adult CHD in medical school curricula. This is not only because of its rich clinical material that students cherish, but also because of the pressing need to encourage clinicians to join the field of adult CHD early in their career development by alerting them to the fascinating clinical and academic adult CHD opportunities that exist.

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Acknowledgements

MA Gatzoulis and the Royal Brompton Adult Congenital Heart Programme have received support from the Waring Trust and the Clinical Research Committee, both at the Royal Brompton and Harefield NHS Trust, and from the British Heart Foundation.

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  1. a Professor of Cardiology and Congenital Heart Disease, a Consultant Cardiologist and the Head of the Adult Congenital Heart Programme at the Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College School of Medicine, London, UK

    Michael A Gatzoulis

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Correspondence to Michael A Gatzoulis.

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Gatzoulis, M. Adult congenital heart disease: education, education, education. Nat Rev Cardiol 3, 2–3 (2006). https://doi.org/10.1038/ncpcardio0382

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