ACC/AHA release updated guidelines for managing adult congenital heart disease - Video

More people than ever before are living long, full lives with congenital heart disease-but adulthood brings new challenges. To guide physicians and patients through this growing frontier, the American College of Cardiology (ACC) and the American Heart Association (AHA) have released updated clinical guidelines for managing congenital heart disease in adults (ACHD). The guideline, jointly published in JACC and Circulation, incorporates the latest evidence from 2017–2024, updating recommendations last issued in 2018.

Congenital heart disease (CHD)-structural defects present at birth-is the most common birth defect, affecting about 1% of newborns in the U.S. thanks to decades of advances in pediatric cardiology and surgery, over 90% now survive into adulthood. But this success has created a new reality: a rapidly growing population of adults with CHD who remain at risk for complications such as arrhythmias, heart failure, and pregnancy-related challenges later in life.

The new guideline expands on several key areas. First, it underscores the critical need for lifelong, specialized care. Many patients lose connection with CHD experts after childhood due to geographic, financial, or awareness barriers. The ACC and AHA now recommend that adults with congenital heart disease be regularly evaluated by, or in consultation with, certified ACHD specialists—especially those with moderate or complex defects.

Another major addition is the guideline’s renewed focus on mental health, cognitive well-being, and exercise. Research has shown that anxiety, depression, and neurocognitive issues are common but underdiagnosed in ACHD patients. Clinicians are encouraged to routinely screen for mental health symptoms and ensure timely referrals. On physical activity, the authors promote personalized exercise testing—not restriction. “We’re now saying adults with CHD are not only allowed but encouraged to be active,” noted Dr. Michelle Gurvitz, chair of the writing committee.

As Dr. Gurvitz explained, “Our most complex patients are our fastest-growing group. These guidelines help ensure that as they live longer, they also live better.” The new framework marks a vital step toward continuous, comprehensive, and compassionate care for adults born with heart disease—a population once deemed untreatable, now thriving well into old age.

REFERENCE: Gurvitz, Michelle, et al.; 2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; Circulation; American Heart Association; doi: 10.1161/CIR.0000000000001402; https://doi.org/10.1161/CIR.0000000000001402