Nachsorge angeborener Herzvitien im Erwachsenenalter: die Rolle der Grundversorger und der Kardiologen in der Praxis

For the long-term follow-up of adults with congenital heart disease (ACHD) a model with delivery of care on three levels has been proposed and in theory is widely accepted. In daily routine however its implementation is sometimes difficult due to regional or local geographical and political circumstances in Switzerland. It remains important to accept that for an adequate care of these patients a minimum of pathophysiological understanding and therefore professional education of medical specialists and training is mandatory. Sufficient patient exposure, ie case-load is also of great importance. On the other hand all patients with ACHD more or less frequently need general medical advice or care for noncardiac problems. This should be delivered locally near the patient’s home and by family physicians. The general practitioner and other primary caregivers as well as the cardiologist without specialist training in ACHD therefore need to have an excellent communication with consultants and specialist centres. This communication should be used with a low threshold and on a bidirectional basis, which is facilitated by personal relationships between local and remote specialist physicians. Such relations can be built during workshops and lectures of continuous medical education. Only a minority of congenital lesions can be dealt with on an exclusively local level without specialist involvement. These are listed in the current guidelines. To avoid disasters it is necessary that caregivers at all levels know the limits of their competence and acknowledge the need for continuous medical education in the field. Zusammenfassung