Treatment of Adults by Pediatric Cardiologists

Late Complication After Surgical Treatment of Aortic Isthmus Stenosis by Michael Huber, Dr. med. Matthias Wolf, and Prof. Dr. med. Harald Dormann in issue 5/2019

The article by Huber et al. (1) shows a typical complication after surgical repair of aortic isthmus stenosis that was recognized late (2, 3). The lack of comprehensive care of grown-ups with congenital heart disease (GUCH; also known as adult congenital heart disease, ACHD) in Germany leads to this type of late diagnosis.

Ongoing care of GUCH-patients could also be taken on by pediatric cardiologists. However, the Baden-Wuerttemberg health insurance and the social courts have recently decided: “[...] treatment of GUCH-patients is to be regarded as outside the specialization of pediatric cardiology and therefore as non-billable”.

Why should the competence of the pediatric cardiologists suddenly vanish, once the patients reach the age of 18? How can congenital heart defect be considered a disease outside of specialization of pediatric cardiologists? Furthermore, pediatric cardiologists can acquire an additional qualification, the GUCH certificate.

This is a transition of the patients, but also of the pediatric cardiologists. This was recognized by the German Medical Association, who implemented a subspecialization training to become a GUCH cardiologist (4). With the acknowledgement of competence of pediatric cardiologists, the German Uniform Value Scale (Einheitlicher Bewertungsmaßstab, EBM) now has to be adapted to implement an adequate follow-up of the GUCH-patient population.

DOI: 10.3238/arztebl.2019.0422a

Dr. med. Matthias Freund
Pediatric cardiologist with GUCH certification
Universitätskinderklinik Klinikum Oldenburg
Medizinischer Campus Universität Oldenburg, Germany

Dr. med. Reinald Motz
Pediatric cardiologist with GUCH certification

Dr. med. Kay Kronberg
Cardiologist with GUCH certification

Paul Hacke
Pediatric cardiologist
University Hospital for Cardiology, Division GUCH

References

1. Huber M, Wolf M, Dormann H: Late complication after surgical treatment of aortic isthmus stenosis. Dtsch Arztebl Int 2019; 116: 62

2. Webb G, Mulder BJ, Aboulhosn J, et al.: The care of adults with congenital heart disease across the globe: Current assessment and future perspective: a position statement from the International Society for Adult Congenital Heart Disease (ISACHD). Int J Cardiol 2015; 195: 326–33

3. Baumgartner H, Bonhoeffer P, De Groot NM, et al.: ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2915–57

4. Bundesärztekammer, Arbeitsgemeinschaft der deutschen Ärztekammern: (Muster-)Weiterbildungsordnung 2018; Berlin: Bundesärztekammer 2018 p. 418.