Although there are data that sexual function is a concern in both women and men, there is minimal evidence on the prevalence of sexual concerns among adults with CHD and far less to guide interventions.S3.13.4-1 Concerns with sexual health are present in 20% to 40% of men with CHD.S3.13.4-2 S3.13.4-4 Erectile dysfunction is reported by up to 42% of men with CHD.S3.13.4-1,S3.13.4-3 Men with CHD report being in sexual relationships sig- nificantly less often than the general population.S3.13.4-1, Among men with CHD who report sexual health concerns, there is a high level of psychological dis- tress and diminished QoL.S3.13.4-1,S3.13.4-2,S3.13.4-4,S3.13.4-5 The ACHD provider should be mindful of this often-unspoken concern and create an environment in which the patient feels comfortable addressing concerns about their sexuality. See Online Data Supplement 21 for referenced studies. CLINICAL STATEMENTS AND GUIDELINES 3.14. Heart Failure and Transplant 3.14.1. Heart Failure Recommendation for Heart Failure Referenced studies that support the recommendation are summarized in Online Data Supplement 22. COR LOE Recommendation I C-LD Consultation with ACHD and HF specialists is recommended for patients with ACHD and HF or severe ventricular Synopsis HF is a significant issue in patients with ACHD. It is com- mon, associated with morbidity and mortality, and is anticipated to increase in prevalence. However, despite the clinical importance of HF in patients with ACHD and efforts to study the effects of medication and device therapy in these patients, there are no data to support treatment recommendations. For patients with biven- tricular physiology, systemic left ventricular (LV) dys- function, no repairable residual hemodynamic abnor- malities, and persistent HF symptoms, standard GDMT is ostensibly preferable to no treatment. 