A Vital Specialty: Adult Congenital Heart Disease

Department of Pediatrics - January 2017

Martin Bocks, MD

Pediatric cardiologists long anticipated that as surgical repair and medical treatments for congenital heart disease (CHD) advanced, eventually the number of adult patients living with congenital heart disease would exceed the number of children living with the same. Though this is now the case, the number of providers trained to specifically deal with the complex needs of adult congenital heart disease (ACHD) patients has not kept pace.

“We started to see CHD patients fall off the survival curve after age 18, and one factor has been the lack of specialized care. Starting more than a decade ago, those who care for these adults focused on developing adult congenital heart disease as its own subspecialty with formalized training and certification. Last year, we were able to offer the first official board-certification exam for ACHD,” said Curt Daniels, MD, Director of the Columbus Ohio Adult Congenital Heart Disease (COACH) and Pulmonary Hypertension Program at The Heart Center at Nationwide Children's Hospital and Professor at The Ohio State University College of Medicine, who serves as Chair of the American Board of Internal Medicine ACHD Exam Committee.

The American Board of Internal Medicine, in a first-time partnership with the American Board of Pediatrics, has introduced this new board certification in ACHD to help overcome the shortage of appropriately trained specialists in the field.

Among the first cohort of 198 board-certified specialists was Martin Bocks, MD, Director, Pediatric Interventional Cardiology, the Congenital Heart Collaborative and the Division of Pediatric Cardiology, University Hospitals Rainbow Babies & Children’s Hospital, and Associate Professor, Pediatric Cardiology, Case Western Reserve University School of Medicine. In consultation with Dr. Daniels through the Congenital Heart Collaborative, Dr. Bocks and Eric Devaney, MD, Chief, Pediatric Cardiothoracic Surgery, UH Rainbow Babies & Children's Hospital and Clinical Professor, Surgery, Case Western Reserve University School of Medicine, are building a comprehensive program for ACHD at University Hospitals.

The program will be a key addition to the nationally recognized UH Harrington Heart & Vascular Institute (HHVI), in partnership with the Division of Pediatric Cardiology at UH Rainbow Babies & Children’s Hospital. Within the Harrington Heart and Vascular Institute, the ACHD initiative is led by Marco Costa, MD, PhD, Institute President and Director of its Interventional Cardiovascular Center, Chief Innovation Officer for University Hospitals, and a Professor of Medicine at Case Western Reserve University School of Medicine.

“So often, adults with CHD are still seeing their pediatric cardiologist for care well into their 30’s and 40’s,” said Dr. Bocks. “Although many ACHD patients have heart anatomy that is better understood by pediatric cardiologists, they can also develop acquired diseases, both cardiac and non-cardiac, that require the additional knowledge possessed by adult cardiologists or other sub-specialists. We need to meet their adult needs in a setting that makes them feel comfortable, while also combining necessary resources and staff from both the pediatric and adult worlds in an effective and convenient way.”

The new program at University Hospitals will feature a multidisciplinary team of adult congenital heart disease experts, including nurse practitioners, nurses and social workers well-versed in the unique challenges of this patient population.

“Having board-certified ACHD cardiologists is the first indicator that an institution is dedicated to meeting the needs of this unique and complicated population. Building a multidisciplinary ACHD team dedicated to patient-centered care to provide comprehensive services is an important next step,” noted Dr. Daniels.

“University Hospitals Cleveland Medical Center is the ideal institution to create a premier program for adults with congenital heart disease,” said Dr. Bocks. “The most successful programs have the ability to send their patients to the optimal location for care, such as from the pediatric operating room for a complex surgical repair to the adult cardiothoracic intensive care unit for post-operative recovery. It is most beneficial when the pediatric and adult cardiology and surgery resources are both institutionally and physically linked, as is the case for our new ACHD program.”

Contact Dr. Bocks at Peds.Innovations@UHhospitals.org.