AHA Statement on Congenital Heart Disease in the Older Adult

Bhatt AB, Foster E, Kuehl K, et al., on behalf of the American Heart Association Council on Clinical Cardiology.
Congenital Heart Disease in the Older Adult: A Scientific Statement From the American Heart Association. Circulation 2015;131:1884-1931.

The following are 10 points to remember about this American Heart Association (AHA) Scientific Statement on the care of older adults with congenital heart disease:

  1. This AHA statement focuses on the care of adults >40 years of age with congenital heart disease (CHD).
  2. The statement demonstrates the challenges in the care of adults with congenital heart disease related to a lack of large clinical studies to inform management decisions. Of a total of 63 individual recommendations, 52 were Level of Evidence C, 10 were level B, and one was Level A.
  3. Atrial septal defect are one of the most common congenital heart defects diagnosed in adults. Older adults may present with increased left-to-right shunting due to adult comorbidities such as ischemic heart disease, hypertension, and diabetes. The decreased left ventricular compliance associated with these disease processes causes increased left-to-right shunting across atrial defects.
  4. Atrial level shunts with right-sided chamber enlargement and without pulmonary hypertension should be closed with a goal of preventing progressive right ventricular dysfunction, improving symptoms, and decreasing the burden of atrial tachyarrhythmias.
  5. In adults with moderate or complex lesions or those with simple lesions with associated cyanosis, pulmonary hypertension, or significant or complicated valve disease, patient evaluation at an adult with CHD (ACHD) center and then coordinated care with a general cardiologist is recommended.
  6. Transplant evaluation should include the risk-benefit assessment not only of the mortality or morbidity of transplant, but also the presence of antibodies secondary to multiple surgeries and the coexistence of multisystem organ dysfunction including pulmonary hypertension, liver disease, and renal disease.
  7. There should be a high index of suspicion for atrial tachyarrhythmias in older adults with CHD. Slower conduction of intra-atrial reentrant tachycardia with 2:1 or 3:1 block may be misinterpreted as sinus rhythm.
  8. Treatment of pulmonary hypertension in patients with CHD with pulmonary vasodilators may be useful and can lead to functional improvement in many diagnoses.
  9. Screening for hepatitis C should be performed in patients who had surgical intervention prior to 1992.
  10. Echocardiography in the older adult with CHD should be interpreted by physicians with expertise in both congenital and acquired heart disease.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Heart Transplant, Pulmonary Hypertension, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Hypertension

Keywords: Cyanosis, Diabetes Mellitus, Echocardiography, Heart Septal Defects, Atrial, Heart Defects, Congenital, Heart Transplantation, Hypertension, Hypertension, Pulmonary, Liver Diseases, Myocardial Ischemia, Risk Assessment, Tachycardia, Vasodilator Agents, Ventricular Dysfunction, Right

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