Heart failure in congenital heart disease: management options and clinical challenges

ABSTRACT

Introduction

The population of adults with congenital heart disease (ACHD) is rapidly expanding and one of the major complications is heart failure. Timely diagnosis and treatment are crucial, but strong evidence for effectiveness of heart failure treatment in ACHD is currently lacking. Components of the medical history, physical examination, and further diagnostic tests including ECG, echocardiography, cardiac magnetic resonance imaging, exercise testing, and biomarkers can identify patients at risk for early mortality or heart failure.

Areas covered

Although the number of studies guiding evidence-based treatment are expanding, many clinical questions have not been completely answered yet. Therefore, in this review we provide an overview of current available insights in epidemiology, diagnosis, risk stratification, and treatment options in ACHD patients, including non-medical therapies and advanced care planning.

Expert opinion

We strongly advocate expanding current use of biomarkers in the diagnostic process and timely initiation of discussing advanced treatment options and advanced care planning with patients and their loved ones. More research in multi-center collaborations is needed to study all aspects of care of adult congenital heart disease patients.

KEYWORDS:

• Risk stratification
• prognosis
• diagnosis
• biomarkers
• heart failure
• treatment
• congenital Heart Defects
• predictors

Article highlights

• Nowadays, most CHD patients will survive into adulthood due to the astonishing improvement in care.

• Heart failure is an important and increasingly prevalent clinical issue in ACHD patients.

• Biomarkers are the cornerstone of heart failure diagnosis.

• There are currently no large clinical trials guiding clinical treatment of heart failure, so multicenter collaboration is essential.

• Advanced care planning is essential and should be discussed early with our patients and their loved ones.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.