Physician’s Weekly: online CME courses, articles on hypertension, arthritis

The American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly released a comprehensive set of practice guidelines for managing adults with congenital heart disease (ACHD). Published in the December 2, 2008 Journal of the American College of Cardiology, these guidelines aim to assist healthcare providers in developing appropriate prevention and management strategies for this challenging group of patients.

The ACC/AHA guidelines, the first of their kind, were developed to describe enough of each variation of ACHD so their management would be understandable to the wide spectrum of providers who serve these patients. The document also reviews clinical evidence from current literature as well as recent advances in the field. Consensus recommendations are provided for the vast majority of ACHD, highlighting common problems and pitfalls encountered by physicians. The guidelines also note when additional resources (eg, a specialized provider or center) are required and how to identify them.

An Urgent Need for Guidance

In the guidelines, the many variations of ACHD are discussed to assist providers who may not have adequate training to manage the disease. Many adult patients wouldn’t survive the disease if not for recent surgical, interventional, and medical advances. Each variation of ACHD requires highly specific and unique management skills. The release of these guidelines is well-timed as the nation’s healthcare system is being confronted and challenged with this new patient population. Physicians must be well informed and equipped to manage ACHD.

In the healthcare system, many patients with ACHD slip through the cracks because they leave the system altogether after being cared for in childhood. Others may not receive optimal care due to a lack of awareness and knowledge from providers. There are several potential explanations for this treatment gap. For example, the extensive care and case management approach provided by pediatric centers may not extend to the adult healthcare system. Another explanation might be that when patients reach the ages of 18 to 21, their care might not be transferred from pediatric caregivers to adult providers. In other cases, there may be delays in the planning and execution abilities for managing ACHD. Lack of insurance and limited access to services and providers who specialize in ACHD are other considerations. The hope is that the ACC/AHA guidelines will narrow the treatment gap by offering resolutions to these problems.

Identifying resources is critical to improving the care of patients with ACHD. The guidelines serve as a “cookbook,” allowing providers to use them to understand how best to manage specific patient groups in the context of ACHD. They also describe scenarios in which specialized providers or centers should be consulted.

The Role of Patient Adherence

Patient adherence to prescribed medical regimens and lifestyles is an important aspect to consider when treating ACHD. The only way the prescribed courses of treatment outlined in the guidelines are effective is if they’re followed. Unfortunately, many patients and the physicians who care for them don’t understand ACHD well enough. As a result, poor adherence may adversely affect outcomes. Physicians and providers should make efforts to engage active patient participation in prescribed management strategies. Ideally, using these guidelines may improve quality of care and patient quality of life. The key is to keep in mind that the ultimate judgment on patient care must be made by the healthcare provider and patients but with an understanding of all of the circumstances presented by each individual patient.

Roberta G. Williams, MD, MACC, FAHA, has indicated to Physician’s Weekly that she has worked as a paid speaker for Harvard and Stanford University, the Universities of Virginia and Michigan, and UCLA. She has also received grants/research aid from the NIH.