Adult congenital heart programs growing more important as time goes on
Advances in the treatment of congenital heart disease have created a growing population of adults who require specialized cardiovascular care, increasing the need for dedicated adult congenital heart disease (ACHD) programs. Dan Halpern, MD, director of the NYU Adult Congenital Heart Program and Klinsky Family associate professor of cardiology at NYU Langone, spoke with Cardiovascular Business about this growing need in a new video interview.
Congenital heart disease affects 1% of the population, and more than 95% of patients now survive into adulthood, Halpern said. That translates into more than 40,000 patients transitioning into adult cardiovascular care each year.
“The field itself is relatively new. It’s very advanced. It’s responsible for a lot of successes that we see, but there is a staffing issue,” he said. “And this is where the general cardiologist is actually a crucial part.”
Halpern emphasized that collaborations between general cardiologists and ACHD specialists are essential. Dedicated programs can serve as the “quarterback” for complex patients, coordinating care among cardiothoracic surgeons, interventional cardiologists, electrophysiologists, pediatric cardiologists and maternal-fetal medicine specialists.
The complexity of these patients also often extends beyond their cardiac anatomy. Many patients have undergone multiple surgeries and face insurance, employment and other socioeconomic challenges. Pregnancy can add yet another layer of complexity.
“Patients could be in their 20s or 30s, but actually their level of medical complexity might mean that biologically they're actually in their 50s and 60s,” Halpern said.
Despite the growing need, specialized programs remain unevenly distributed. Halpern said not every state has an ACHD program, although accreditation through the Adult Congenital Heart Association has helped establish standards for comprehensive centers. Those standards address staffing and support services, including social workers, psychologists and care coordinators.
Specialty expertise is known to improve outcomes. Halpern said evidence increasingly indicates that patients treated at institutions with ACHD expertise have better survival, underscoring the importance of referrals and second opinions for complex cases.
At NYU, multidisciplinary meetings bring specialists together to review complicated cases and develop treatment plans. The program, which began about a decade ago and also serves patients on Long Island and through collaborations in New Jersey, now sees more than 4,000 patients annually.
Technology is also expanding the field. Halpern pointed to emerging applications of artificial intelligence in electrocardiography and echocardiography that could help identify congenital abnormalities earlier. Meanwhile, transcatheter treatments pioneered in congenital heart disease are increasingly replacing surgery.
Pulmonary valve replacement, for example, has shifted toward transcatheter approaches, he said.
“It's amazing that we used to do pulmonary valve replacements through surgery,” Halpern said. “Most of the cases these days we do through transcatheter approach and it has changed the whole field.”
With more patients surviving to adulthood, Halpern said ACHD care increasingly requires a combination of specialized expertise, multidisciplinary collaboration, standardized guidelines, advanced technology and social support.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]