The incidence of congenital heart disease (CHD) in Singapore is 0.81% of total live births based on the birth defect registry from 1994-2000. In Singapore, with an estimated population of around 4.3 million, the estimated number of adults with CHD would be in the region of 12,000 adults with an extra 300-320 cases added annually, assuming an annual birth of 37,000 – 40,000 newborns. It is estimated that in the next decade, the number of adult patients with congenital heart disease worldwide will exceed their paediatric counterparts.
Despite their improved life expectancy, congenital patients stepping into adulthood face many issues:
In the past, these adult patients were usually managed by paediatric cardiologists who, although excellent in interpreting and comprehending the underlying physiology and haemodynamics, were nonetheless ill-equipped in managing adult related problems like coronary artery disease, pregnancy and contraception, arrhythmias,hypertension. Research has shown that ACHD patients especially those of moderate to severe complexity do better when their care is centralised to a dedicated specialised ACHD unit.
Having survived into adulthood, ACHD patients are now facing a new set of challenges encompassing not only medical or surgical problems but extending to psychological, vocational and lifestyle issues. Congenital heart disease is a heterogenous condition with a wide spectrum of varying complexity and severity. Therefore, all ACHD patients (with the exception of those with mild isolated valvular heart disease or those with repaired patent ductus arteriosus, ventricular septal defect and atrial septal defect) should be followed up in a specialised ACHD unit with a dedicated multidisciplinary team who can anticipate the various issues particular to each individual. Only then can we provide adequate care and work towards improving the clinical outcome of this special group of patients.
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