AHA/ACC vs ESC Guidelines for Management of Adults With Congenital Heart Disease
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The American Heart Association and American College of Cardiology published practice guidelines for the management of adult congenital heart disease in 2018 and the European Society of Cardiology published analogous guidelines in 2020. Although there are broad areas of consensus between the 2 documents, there are important differences that impact patient management. This review discusses key areas of agreement and disagreement between the 2 guidelines, with discussion of possible reasons for disagreement and potential implications.
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Subjective evaluation of symptoms in repaired TOF patients may be inaccurate, and CPET is currently recommended as part of follow-up to monitor patients and support treatment decisions such as pulmonary valve replacement.
“Subjective evaluation of symptoms in these patients may be inaccurate; thus, exercise tests are routinely performed to assess them objectively. Particularly, cardiopulmonary exercise testing (CPET) is currently recommended as part of the follow-up of patients with TOF to monitor patients and support treatment decisions, such as pulmonary valve replacement [88,89].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [88]
Table 6 lists reduced objective exercise capacity among considerations for pulmonary valve replacement in asymptomatic patients with repaired tetralogy of Fallot. The “Other Topics” section says the ESC includes cardiopulmonary exercise testing in the diagnostic work-up for adults with congenital heart disease. Neither passage says subjective symptom assessment in repaired TOF is inaccurate or specifically recommends CPET as a routine part of TOF follow-up; page numbers were unavailable in our copy. (LLM, conf=0.85)
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- Authors
- Egidy Assenza, G., Krieger, E. V., Baumgartner, H., Cupido, B., Dimopoulos, K., Louis, C., Lubert, A. M., Stout, K. K., Valente, A. M., Zeppenfeld, K., & Opotowsky, A. R.
- Affiliations
- Seattle Children's Hospital (US)
- University Hospital Münster (DE)
- University of Cape Town (ZA)
- Royal Brompton Hospital (GB)
- University of Rochester Medicine (US)
- Cincinnati Children's Hospital Medical Center (US)
- Brigham and Women's Hospital (US)
- Leiden University Medical Center (NL)
- Corresponding author
- Opotowsky, Alexander R.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 78
- Issue
- 19
- Pages
- 1904-1918
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W3209447019
- Cited by
- 70
- References
- 18
- Citations by year
- 2026: 19 · 2025: 10 · 2024: 21 · 2023: 15 · 2022: 5
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- adult congenital heart disease, ACC/AHA guidelines, ESC guidelines, guideline comparison, clinical management
- MeSH terms
- Adult, American Heart Association, Heart Defects, Congenital, Humans, Patient Care Management, United States, Practice Guidelines as Topic
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