Adult Congenital Heart Disease in the Aging and Elderly Population

Purpose of Review Since the turn of the 21 st century, there have been more adults than children living with congenital heart disease. Owing to advances in care, this population of patients with adult congenital heart disease (ACHD) is now living to older ages. Despite improved survival, however, elderly patients with ACHD and providers together face unique challenges given the limited knowledge and experience in caring for this cohort. In this review, we describe some of these challenges and highlight important aspects in the care of aging and elderly patients with congenital heart disease. Recent Findings In adulthood, patients with ACHD frequently develop acquired heart disease as either a sequelae of their underlying anatomy and prior repairs, or as a result of the high concurrence of traditional risk factors and comorbidities. Combined congenital and acquired heart disease may manifest differently than acquired heart disease in a structurally normal heart and frequently does not have evidence to support use of existing guideline-directed medical treatment. Elderly patients with congenital heart disease are also at increased risk for certain medical comorbidities such as cancer, dementia, and mood disorders as a result of lifelong illness and prior treatment. As a result of these medical and psychosocial complexities, patients with ACHD have more frequent presentations to care including in the hospital and intensive care unit settings, but frequently find themselves and their medical teams inadequately equipped to deal with end-of-life care and decision making. Summary In the wake of a growing population of elderly ACHD patients and the evolving landscape of ACHD, it is imperative that special considerations in the care of this population be addressed.