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J Am Coll Cardiol. 2012 Dec 11;60(23):2411-8. doi: 10.1016/j.jacc.2012.09.015. Epub 2012 Nov 7.

Referral patterns and perceived barriers to adult congenital heart disease care: results of a survey of U.S. pediatric cardiologists.

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Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA 94304, USA.



This study sought to elucidate referral patterns and barriers to adult congenital heart disease (ACHD) care, as perceived by pediatric cardiologists (PCs).


Management guidelines recommend that care of adults with moderate/complex congenital heart disease be guided by clinicians trained in ACHD.


A cross-sectional survey was distributed to randomly selected U.S. PCs.


Overall response rate was 48% (291 of 610); 88% (257 of 291) of respondents met inclusion criteria (outpatient care to patients >11 years of age). Participants were in practice for 18.2 ± 10.7 years; 70% were male, and 72% were affiliated with an academic institution; 79% stated that they provide care to adults (>18 years). The most commonly perceived patient characteristic prompting referral to ACHD care was adult comorbidities (83%). The most perceived barrier to ACHD care was emotional attachment of parents and patients to the PC (87% and 86%, respectively). Clinician attachment to the patient/family was indicated as a barrier by 70% of PCs and was more commonly identified by responders with an academic institutional affiliation (p = 0.001). A lack of qualified ACHD care providers was noted by 76% of PCs. Those affiliated with an academic institution were less likely to identify this barrier to ACHD care (p = 0.002).


Most PC respondents in the United States provide care to ACHD patients. Common triggers that prompt referral and perceived barriers to ACHD care were identified. These findings might assist ACHD programs in developing strategies to identify and retain patients, improve collaborative care, and address emotional needs during the transition and transfer process.

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