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Training to care for adults with congenital heart disease in the USA and Europe
  1. Amanda W Cai1,
  2. Andrew Constantine2,
  3. Ylenia Bartolacelli3,
  4. Eric V Krieger1
  1. 1 Adult Congenital Heart Disease, The University of Washington, Seattle, Washington, USA
  2. 2 Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
  3. 3 Pediatric Cardiology and GUCH Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Italy
  1. Correspondence to Dr Amanda W Cai, Adult Congenital Heart Disease, The University of Washington, Seattle, WA 98195, USA; amandawcai{at}

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Introduction to ACHD

In recent decades, the subspecialty of adult congenital heart disease (ACHD) has emerged in order to care for the expanding population of adult survivors born with congenital heart disease (CHD). Accordingly, cardiovascular societies have swiftly developed pathways for training, accreditation, and standardisation of clinical practice. Prior to 2015, there were neither training standards nor board certification for ACHD in the USA. In the European Union (EU), there is still no board certification for specialists in ACHD. Despite the rapid development of these standards and metrics, the workforce of specialised physicians available to care for these patients has not kept pace with the growth of patients, and the USA places the ratio of patients to board-certified ACHD physicians at 4500:1, five times that of general cardiology patients to general cardiologists.1

Training pathways

Postgraduate training programmes allow matriculation in formalised ACHD fellowships from multiple training pathways. In the UK, 2-year ACHD subspecialty training blocks are offered to physicians with a national training number in adult or paediatric cardiology, supplemented by locally arranged, informal fellowship posts. A shorter period of ACHD training can be combined with another subspecialty, such as advanced imaging, for those aiming to work as a cardiologist with …

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  • Contributors AC is the first author and primary writer of this Cardiology in Focus article. EK is the last author and guarantor of the article. AHC and YB added perspective to this article from a UK and EU training standpoint and provided critical review and revisions to the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.