Adult Congenital Heart Service

Transition clinic

Patients who have had chronic childhood illness can benefit from transitioning into an adult program designed specifically to meet their needs. Programs for adults with congenital heart disease differ from the pediatric model in the following ways:

• Focus on physical aging: Adults are physically aging rather than physically developing. Adults with chronic illness often age at an accelerated rate physically, leading to early development of multiple adult-type co-morbidities. This is addressed in an adult program.
• Focus on adult-type co-morbidities: These co-morbidities are often different than pediatric chronic issues. For example, the management of diabetes, kidney disease, systemic hypertension, liver disease, psychiatric illness and even heart failure and arrhythmias are different in the adult versus the pediatric patient.
• Change in hospital visit dynamics: The dynamics of the visit evolve from a doctor-parent-patient triangle to a simple doctor-adult relationship. This, of course, doesn’t mean that family members shouldn’t be included. It just means that the relationship is patient-focused.
• Focus on problem-solving strategies: As young people develop, they move from using emotional coping strategies to problem-solving strategies. Chronic illness often interferes with this development and has been associated with depression and anxiety. An adult clinic can focus on, and recognize the importance of developing these strategies.
• Focus on patient education: An adult clinic works to promote a patient’s understanding of his cardiovascular issues, including basic anatomy and physiology of his congenital heart disease and surgical repair. An adult clinic also helps patients be aware of potential problems they may face in the future, with an emphasis on the importance of follow-up, adherence to medical and preventive care. This includes:
  • knowing which signs and symptoms are important to watch for
  • knowing why certain medications are prescribed and the potential side effects
  • being informed about major generic health issues like sexual health, substance abuse, exercise and nutrition and insurability