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American Heart AssociationCardiology2025advanced

Management of Adults With Congenital Heart Disease

Published by ACC/AHA Joint Committee on Clinical Practice Guidelines · Class of Recommendation (COR) and Level of Evidence (LOE)

Summary

AI-generated

Reviews the background and history of ACC/AHA guidelines, ACC/AHA missions, governance, values and principles related to guideline development, format of guideline documents, and guideline optimization.

congenital heart diseaseadult congenital heart diseaseACC/AHAcardiologyguidelinesrecommendationslifelong carerisk stratification

What's New in This Version

Revised Section 3.4.5 to include change to consensus threshold from >51% to >75%. Added New Section 3.7 Phase 4. Post-Publication Surveillance Review and Guideline Revision to detail purpose, scope, surveillance process, and pathways for updates and reaffirmation.

Key Recommendations

Economic Value Statements

1
In patients with symptomatic chronic heart failure with reduced ejection fraction, SGLT2 inhibitors are recommended to reduce hospitalization for heart failure and cardiovascular mortality, irrespective of the presence of type 2 diabetes.
1Evidence: ATherapeutic

9.5.1. Treating Hypertension to Reduce the Incidence of Heart Failure

1
In patients at increased risk, stage A HF, the optimal blood pressure in those with hypertension should be less than 130/80 mm Hg.
1Evidence: C-LDManagement

Background Questions

1
In patients with clinically suspected moderate or greater degrees of valvular stenosis who have not undergone preoperative echo within 1 year, echo should be performed/is recommended if there has been a significant change in clinical status or physical examination since the last patient exam.
1Evidence: C-LDDiagnostic

Initial Diagnosis and Surveillance Imaging

1
In patients with Marfan syndrome, a TTE is recommended at the time of initial diagnosis, to determine the diameters of the aortic root and ascending aorta, and 6 months thereafter, to determine the rate of aortic growth; if the aortic diameters are stable, an annual surveillance TTE is recommended.
1Evidence: C-EODiagnostic

4.1.7. Shared Decision-Making in Patients With Acute Chest Pain

2
For patients with acute chest pain and suspected ACS who are deemed intermediate risk by a CDP, shared decision-making between the clinician and patient regarding the need for admission, for observation, discharge, or further evaluation in an outpatient setting is recommended for improving patient understanding and reducing low-value testing.
1Evidence: B-RManagement

Scope & Objectives

Clinical Topic

Cardiovascular Disease

Objectives

To describe how the processes of ACC/AHA guideline development are applied to ensure there is consistency across all guidelines.

Target Patient Population

Patients with cardiovascular conditions

Target Providers

Cardiovascular cliniciansPrimary care clinicians

Patient Criteria & Setting

Therapeutic Area

Cardiology

Guideline Scope

Guideline Development Methodology

Evidence Grading

System: Class of Recommendation (COR) and Level of Evidence (LOE)

Evidence Levels

Level AHigh-quality evidence from more than 1 RCT, meta-analyses of high-quality RCTs, or one or more RCTs corroborated by high-quality registry studies.

Level B-RModerate-quality evidence from 1 or more RCTs or meta-analyses of moderate-quality RCTs.

Level B-NRModerate-quality evidence from 1 or more well-designed, well-executed nonrandomized studies, observational studies, registry studies, or meta-analyses of such studies.

Level C-EOConsensus of expert opinion based on clinical experience.

Level C-LDRandomized or nonrandomized observational or registry studies with limitations of design or execution. Meta-analyses of such studies. Physiological or mechanistic studies in human subjects.

Recommendation Strength

Class 2b (Weak)Benefit >= Risk

Class 1 (Strong)Benefit >>> Risk

Class 2a (Moderate)Benefit >> Risk

Class 3: Harm (Strong)Risk > Benefit

Class 3: No Benefit (Moderate)Benefit = Risk

Authors & Contributors

Catherine M. OttoSunil V. RaoJoshua A. BeckmanAbdul R. AbdullahHani JneidAnastasia ArmbrusterHeather M. JohnsonVanessa BlumerWilliam Schuyler JonesLeslie L. DavisSadiya S. KhanSharlene M. DayMichelle M. KittlesonRebecca L. DiekemperVenu MenonDave L. DixonDebabrata MukherjeeVictor A. FerrariDaniel MuñozStephen E. FremesKristen K. PattonMario GaudinoGarima SharmaThomas S. D. GetchiusDaichi ShimboBoback Ziaeian

Guideline Features

Flowcharts includedMultidisciplinaryPatient involvement

Learning Context

Difficulty

advanced

Learning Paths

Guideline MethodologyEvidence-Based MedicineSystematic ReviewShared Decision-MakingLiterature Surveillance