What follow-up care is recommended for adults with a history of congenital heart disease?

Adults with a history of congenital heart disease require lifelong follow-up care tailored to the complexity and stability of their condition. Regular specialist cardiology review is essential, particularly for those with moderate to severe residual defects, valve disease, or prior interventions, to monitor cardiac function and detect complications early ¹. This includes clinical assessment of symptoms such as palpitations, breathlessness, oedema, and syncope, alongside physical examination focusing on pulse rate and rhythm, and echocardiographic surveillance to evaluate structural and functional status ¹.

Monitoring of heart failure symptoms and management of comorbidities is critical, as adults with congenital heart disease may develop heart failure or arrhythmias; referral to heart failure services and multidisciplinary teams including heart failure nurses and pharmacists is recommended for optimisation of treatment and education ¹,⁴. Regular assessment of renal function, electrolytes, and medication side effects should be performed, with frequency individualized based on clinical stability, typically at least every 6 months if stable ¹,⁴.

Psychosocial assessment including screening for depression and anxiety is advised, with reassessment after stabilisation of physical symptoms, as psychological health significantly impacts outcomes ¹. Nutritional status should be evaluated, with dietetic referral if underweight or obese ¹.

Vaccinations against influenza annually and pneumococcal disease once are recommended to reduce infection risk in this vulnerable population ¹,⁴.

For women of childbearing age, counselling on contraception and pregnancy risks is important, with specialist cardiology and obstetric collaboration for those planning pregnancy or who become pregnant, given the increased maternal and fetal risks associated with congenital heart disease ¹,³. Pregnancy management should involve multidisciplinary teams to optimise maternal cardiac status and plan delivery ²,³.

Exercise-based rehabilitation programmes tailored to the individual's cardiac status may be beneficial to improve functional capacity and quality of life ¹.

Recent literature on adult congenital heart disease, such as management of atrial septal defects, supports the importance of individualized follow-up strategies that include regular imaging and arrhythmia surveillance to prevent late complications (Rigatelli et al., 2007). This aligns with guideline recommendations emphasizing specialist assessment and monitoring.