New Congenital Heart Disease Clinical Guidelines Issued By AHA

Major changes have been made to the recommended guidelines for treating congenital heart disease among adults, including new ways to classify the condition. 

The guidelines have not been updated since they were first established in 2008. However, this week the American College of Cardiology (ACA) and the American Heart Association (AHA) released the new recommendations in a report published in the medical journal Circulation.

The biggest change is the addition of a classification system, which is designed to help doctors focus on treating adult patients with congenital heart disease on an individual basis and provide follow-up based on that classification. The new classification still includes the three established anatomic categories of complexity first used in 2008: simple, moderate, and great. However, the new guidelines add physiologic classifications A through D.

Congenital heart disease has a wide range of structural cardiac abnormalities present before birth and linked to fetal cardiac development.

The new classifications take into account the physical abnormalities of the heart as well as the patient’s functional status and other factors, including the presence of cardiovascular and non-cardiovascular problems. These factors are then combined with anatomic categories and classified IB-D, IIA-D, and IIIA-D, similar to the AHA heart failure stages.

Researchers say the new classifications help doctors make recommendations for clinical follow-up and testing, such as electrocardiograms, MRI , etc.

The guidelines also emphasize adult congenital heart disease patients should be managed in collaboration with an adult congenital heart disease (ACHD) certified cardiologist. While most guidelines focus on how to treat patients, this guideline includes instructions on which doctors should treat patients.

The new guidelines call for specialized care from ACHD cardiologists, since not all cardiologists are familiar with this patient population.

Survival rates of children with congenital heart disease have greatly changed since 2008. Survival rates have increased the number of patients with the condition to 1.4 million in the United States.

Conversely, there are only 300 board-certified adult congenital heart disease cardiologists in the country. While hospital training programs have been added at 11 hospitals across the country, the number of trained specialists who are familiar to treat this specialty are few.

The new guidelines hope to direct patients to the trained and board-certified ACHD cardiologists so these patients may receive better care.

The new guidelines were developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.