A wave of a new patient population is hitting the adult health care system: adults with congenital heart disease (CHD). We have become the victim of the advances in medicine, pediatric cardiology and congenital surgery during the last 60 years. The number of adults with CHD is continuously growing, the prevalence of complex CHD is increasing more rapidly in adults than in children, and morbidity and mortality are shifting away from the young and towards the adult. Despite the fact that the prevalence of adult CHD (ACHD) is significantly higher than that of other diseases (e.g. HIV, cerebral palsy, Parkinson disease), public awareness of ACHD is poor and must be improved. An enormous investment for children with CHD was made and allowed them to survive until adulthood, but the adult health care system is not prepared to provide adequate resources (human resources and infrastructure) for the provision of the same quality of care as the patients received in the pediatric health care system. The provision of care for ACHD patients is suboptimal in many countries as many ACHD healthcare programs do not comply with the standards of optimal care structure. Progresses have been made, but they don't cover the needs and there is much room for improvement. Authorities must develop a regional and national care plan, must identify regional and supraregional referral centers which meet the criteria for quality of care. Spain would need up to 20 regional ACHD centers to provide care for their ACHD population of more than 125,000 patients. We must validate the enormous investment that was made in these patients during childhood and bring one of the biggest success stories in medicine to fruition: sustained efforts are needed to implement the recommendations of care for ACHD patients, to get accreditation for the programs and training in ACHD. Governments, ministries of health, and healthcare providers are challenged to provide adequate human, financial and structural resources to meet the increasing needs of this growing and challenging ACHD population. We have an ethical responsibility to provide the best quality of care to patients born with a handicap as we have for patients with acquired diseases. An integrated (ACHD and pediatric) care program with consolidation of core diagnostic and therapeutic procedures in buildings and areas dedicated to CHD, pooling of specialized adult and pediatric talents, skills and resources would best serve patient care, education and research relative to CHD. © 2009 Sociedad Española de Cardiología.
Notker Oechslin, E. (2009). Modelos de asistencia sanitaria en Europa y América del Norte. Revista Espanola de Cardiologia Suplementos, 9(5). https://doi.org/10.1016/S1131-3587(09)73292-3