Feature | December 14, 2012

Adult Congenital Heart Disease Designated as Subspecialty

Congenital Heart Disease Certification American Board of Medical Specialties

December 14, 2012 — More than a million adult congenital heart disease patients in the United States will soon be able to choose a specialist who has demonstrated the unique knowledge and skills their care requires thanks to a new subspecialty certification for adult congenital heart disease approved by the American Board of Medical Specialties (ABMS).

“This decision marks a great day for patients with adult congenital heart disease and their doctors,” said American College of Cardiology (ACC) President William Zoghbi, M.D., FACC. “The advances in cardiology over the past several decades mean that the majority of pediatric congenital heart disease patients are surviving well into adulthood and even old age. This is very good news but with it comes the need for a more specialized focus on this type of patient. The certification in adult congenital heart disease subspecialty allows this growing group of patients to have their unique cardiac needs met and lifts some of the burden on pediatric cardiologists who may not be appropriately trained in adult health issues.”

Adult congenital heart disease patients have now surpassed the number of pediatric patients needing care, which was unheard of only a few decades ago. These adults require specialized care throughout their lives; however, only about 10 percent of these patients are seeking appropriate care from adult congenital cardiologists. It is estimated that, at most, only 50 percent of those with adult congenital heart disease receive any sort of cardiovascular care.

In 2008, the ACC’s Adult Congenital and Pediatric Cardiology Council, led by Gerard Martin, M.D., FACC, spearheaded a multisociety effort to petition the American Board of Internal Medicine and American Board of Pediatrics for an adult congenital heart disease subspecialty certification. Pediatric and adult congenital cardiology leaders Curt Daniels, M.D., FACC, Michael Landzberg, M.D., FACC, and Thomas Graham, M.D., FACC, co-chaired the petition writing groups. The ABMS Board of Directors announced it has approved the certification.

The subspecialty certification exam will be available in the next two to three years and will be open to pediatric cardiologists and internal medicine cardiologists who have completed a two-year adult congenital heart disease training program.

“Providing lifelong specialized care for all congenital heart disease patients is critical to the health and well-being of each of the more than one million adults currently living with this condition,” said Kathy Jenkins, M.D., MPH, FACC, chair of the ACC’s Adult Congenital and Pediatric Cardiology Council. “This subspecialty is an important milestone in serving these patients and providing them the best possible care.”

The ABMS created the physician certification in the new subspecialty of adult congenital heart disease (ACHD). The ABMS Board of Directors and ABMS Reserved Powers Board approved the subspecialty at its September 2012 meeting. The subspecialty will be offered by the American Board of Internal Medicine (ABIM) and will create a pathway for certification for cardiologists previously certified by either the ABIM or the American Board of Pediatrics (ABP) with the expectation that the certification exam will be available within the next three years.

The Accreditation Council for Graduate Medical Education (ACGME) will be approached to develop accreditation standards for training programs very shortly.

“Children who suffer from pediatric congenital heart disease are now surviving into adulthood, with specialized medical needs that will be best met by trained specialists in adult congenital heart disease,” noted Eric Holmboe, M.D., FACP, ABIM’s chief medical officer. “This new subspecialty will enable patients to identify those clinicians with the competence and skill necessary to deliver quality care.”

The ACHD subspecialty will:

  • Meet the needs of the growing population of adults with congenital heart disease by ensuring there are enough physicians with the appropriate training to care for them in a consistent and comprehensive manner that is in compliance with recently published guidelines;
  • Enable adult congenital heart specialists to work in an environment that specializes in caring for this patient population and provides a mechanism for transition of care from adolescence to adulthood that would eliminate gaps in medical care; and
  • Develop well-defined training pathways for internal and pediatric medicine cardiology trainees through the ABIM and the ABP. These pathways would culminate in a final common examination and subspecialty certification available.

More than one million adults in the United States live with congenital heart disease, nearly half of which require lifelong cardiac care, according to the Adult Congenital Heart Association. Currently, there are an estimated nine ACHD training programs in the United States. Estimates are that there are 500 to 600 certified ACHD cardiologists needed to serve patients and this will continue to grow with advances in care for the treatment of congenital heart disease.

“This new subspecialty will lead to an increased supply of physicians who are appropriately trained and qualified to provide care for these unique patients. As a result, the public will be better served by assuring that these adults can receive the same high quality care as are children suffering from congenital heart disease,” stated ABP president and CEO James A. Stockman III, M.D.

For more information: www.cardiosource.org/ACC, www.abms.org

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