Due to successes in treating congenital heart disease (CHD) in childhood, more children with CHD are surviving to adulthood—resulting in more adults with CHD than children in the United States. The number of adults with CHD continues to grow every year.
From its inception more than 20 years ago, the Adult Congenital Heart Association (ACHA) knew our members struggled to find appropriate cardiology care. In 2001, ACHA first endorsed the creation of specialized adult congenital heart disease (ACHD) training.
At that time, most cardiologists who took care of ACHD patients were self-trained. Only a few had formal training in ACHD. Some pediatric cardiologists continued to see their patients as adults. However, they did not have training and education in the unique health challenges of ACHD patients. General cardiology programs only offered six hours of training in ACHD, which was primarily lecture-based. It did not require trainees to see an ACHD patient.
In 2008, the American College of Cardiology’s (ACC) Adult Congenital and Pediatric Cardiology Council, with the support of ACHA and other cardiology organizations, led the way to petition the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics to create subspecialty certification for ACHD. During this time, ACC took the lead in drafting formal education requirements for ACHD specialty care and invited ACHA input and support. More than 100 ACHA members submitted letters to ACC describing their struggles in finding doctors capable of caring for their rare and life-threatening health issues.
This effort resulted in the establishment a new physician cardiovascular subspecialty, Adult Congenital Heart Disease, in December 2012. A pathway for certification was now available for cardiologists fully trained and already certified by either ABIM or ABP. It was a day of great success for patients living with congenital heart disease and their providers.
“ACHD board certification is important because it is one tool to help identify a cardiologist as having ACHD expertise,” said Peter Ermis, MD, Medical Director of the ACHD Program at Texas Children’s Hospital and an ACHA Medical Advisory Board Member. “ACHA has spent a lot of time, and done a great job, trying to provide the message that adults with congenital heart disease should be seen by ACHD experts due to the unique nature of their hearts. Prior to ACHD board certification and ACHA program accreditation, it was oftentimes difficult for patients to find and properly identify a provider with ACHD expertise.”
The first board certification exam was given in October 2015; to date, there have been four total exams. It is estimated that there are more than 450 board certified ACHD cardiologists. Still, more ACHD board certified doctors are needed to meet the patient need.
For the first three exams, candidates who were board certified by either ABIM or ABP could sit for the exam by one of two paths:
- The practice pathway, which required no formal training.
- The training pathway, which required completion of a 24-month ACHD fellowship.
The practice pathway has since been discontinued. Starting with the fourth exam, which took place on October 14, 2021, all candidates for ACHD board certification must have completed a 24-month ACHD fellowship to sit for the exam.
“The specialty of adult congenital heart disease is very early in its lifespan – having only had board certification for six years,” according to Dr. Ermis. “Just like all other specialties, the board certification process will need to continuously adapt to the needs of the field, the providers in the field and, most importantly, the ACHD patients. We will likely need to adapt the process in an effort to recruit more providers into the ACHD specialty while at the same time maintaining the high level of expertise that our patients come to expect when seeing an ACHD expert provider.”
We’ve come a long way in the past 10+ years to assure that ACHD patients get care from cardiologists who have the appropriate knowledge and training. ACHA will continue to work to improve the care for all ACHD patients.