Adult congenital heart disease transition — branching viva

Branching viva on the transition of the adolescent with congenital heart disease to lifelong adult ACHD care: defining transition as a process, building and measuring readiness, matching surveillance to complexity, preventing loss to follow-up, and counselling on contraception, pregnancy risk by the modified WHO classes, and targeted infective endocarditis prophylaxis.

branching clinical structured oral3 min readVerification in progress

Prompt

Adolescent cardiology clinic: an 18-year-old woman with transposition of the great arteries repaired by an atrial (Mustard) switch in infancy attends before moving cities for university. She feels well, takes no regular follow-up seriously, and has not thought about contraception or the future. Her last echocardiogram noted mild systemic right-ventricular dysfunction. She is about to leave paediatric care.

Branch 1 — Define the task

Examiner: She is about to leave paediatric care. What is your overall goal, and what is the difference between transition and transfer? [3]

Candidate: My goal is to get her safely into lifelong adult ACHD care without a gap. Transition is the planned, staged process of preparing her and her family for that move — building her knowledge of her own anatomy, her self-management, and her self-advocacy over years. Transfer is only the single event of her first adult appointment. The danger is treating the transfer as the whole task and discharging her with a letter; that is how young people fall out of care. I want a deliberate process ending in a confirmed appointment at a named adult centre, ideally near her new university city. [3] [1]

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References9Show ledger

[1]Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease J Am Coll Cardiol, 2019.PMID 30121239
[2]Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J, 2021.PMID 32860028
[3]Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, et al. Best practices in managing transition to adulthood for adolescents with congenital heart disease: the transition process and medical and psychosocial issues: a scientific statement from the American Heart Association. Circulation, 2011.PMID 21357825
[4]Mackie AS, Ionescu-Ittu R, Therrien J, Pilote L, Abrahamowicz M, Marelli AJ Children and adults with congenital heart disease lost to follow-up: who and when? Circulation, 2009.PMID 19597053
[6]Gurvitz M, Valente AM, Broberg C, Cook S, Stout K, et al. Prevalence and predictors of gaps in care among adult congenital heart disease patients: HEART-ACHD J Am Coll Cardiol, 2013.PMID 23542112
[7]Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018.PMID 30165544
[8]Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, et al. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 2017.PMID 28082385
[11]Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, et al. Prevention of infective endocarditis: guidelines from the American Heart Association Circulation, 2007.PMID 17446442
[14]Sawicki GS, Lukens-Bull K, Yin X, Demars N, Huang IC, et al. Measuring the transition readiness of youth with special healthcare needs: validation of the TRAQ J Pediatr Psychol, 2011.PMID 20040605