Growing Need for Specialized Care of Adults with Congenital Heart Disease in the ICU
A new state-of-the-art review published in JACC: Advances highlights the increasing need for specialized care systems, research, and training for adults with congenital heart disease (ACHD) requiring intensive care.Authored by Christopher W. Valle, MD, Anne Marie Valente, MD, FACC, and colleagues from the ACC Critical Care Cardiology and Adult Congenital and Pediatric Cardiology Sections, the review addresses the growing complexity of this patient population and the emergence of critical care cardiology as a subspecialty.
The authors detail the current landscape of ACHD patients in the ICU, reviewing key physiological considerations and management strategies for conditions like Fontan circulation, systemic right ventricle, and Eisenmenger syndrome. They identify both cardiac and non-cardiac risk factors impacting outcomes and pinpoint gaps in existing evidence.
Key recommendations and areas for focus include:
Research: Prioritizing the collection of data on the changing demographics of ACHD patients and leveraging resources like ACHD provider networks, registries, databases, and machine learning to improve risk prediction and intervention timing. Evaluating the effectiveness of current risk prediction tools is also crucial. Workforce advancement: Given the limited number of intensivists with specialized ACHD training, the authors advocate for collaborative, multidisciplinary ICU teams proficient in both ACHD and critical care. These teams should be actively involved in daily patient rounds. Expanding educational programs to include advanced practice providers and offering outreach to centers lacking ACHD consultation are also vital. A standardized, competency-based curriculum spanning multiple disciplines is needed.
* Standardization of Care: addressing the current variability in critical care practices for ACHD patients through the development of evidence-based clinical practice guidelines and standardized care delivery models to improve outcomes across all ICU settings.
This review underscores the urgent need for a coordinated approach to improve the care of adults with congenital heart disease in the critical care setting.
