Pediatric Nurse Practitioners in Adult Congenital Heart Disease Care

Adults with congenital heart disease face myriad difficulties in obtaining care from providers and hospital systems knowledgeable about their conditions and health care needs. Increasingly, specialized programs are being developed to provide services to the adult congenital heart disease (ACHD) population with beneficial results ( ). However, many of these dedicated programs are based at university-affiliated children's hospitals, owing to the familiarity of pediatric cardiologists and congenital heart surgeons with ACHD anatomy and physiology. Inevitably, when an ACHD patient requires surgical intervention, the patient is faced with the unusual choice of having heart surgery in an adult facility or in a Children's Hospital. The work of Karamlou et al. ( ) has informed this decision by showing that a survival advantage may exist for ACHD patients receiving operative care from congenital heart surgeons, who largely practice within pediatric facilities, though this conclusion is controversial ( ). Nonetheless, many ACHD patients elect to have surgery at children's hospitals ( ). Outcomes from these operations are excellent, undoubtedly due in part to the meticulous care provided postoperatively in the cardiac intensive care unit (ICU) by teams of providers who work in a highly integrated fashion, both for children and adults ( ; ).