Appropriate specialty care must be available to address pregnancy, acquired cardiovascular disease, and acute noncardiac illness complicating CHD, man- agement of which is frequently more complicated in patients with ACHD. Although individual providers may be communi- ty-based affiliates, ACHD programs are inpatient, outpatient, and hospital-based with staffing and ex- pertise available on-site or accessible when needed (Table 5). 3.2. Access to Care Recommendation for Access to Care Referenced studies that support the recommendation are summarized in Online Data Supplement 3. COR LOE Recommendation I B-NR Physicians caring for patients with ACHD should support access to care by a) assuring smooth transitions for adolescents and young adults from pediatric to adult (Level of Evidence: B-NR); and b) promoting awareness of the need for lifelong specialized care through outreach and educational programs (Level of Evidence: C-EO). C-EO Synopsis As patients with ACHD grow beyond the pediatric age group, continued access to specialized cardiovascular care presents several challenges: Lack of guided transfer from pediatric to adult care; Insufficient availability of ACHD programs; Inadequate insurance coverage; Deficient education of patients and caregivers regarding ACHD; Inadequate resources for patients with cognitive or psychosocial impairment; Lack of comprehensive case management; and Table 5. Key Personnel and Services Recommended for ACHD Programs Personnel ACHD board-eligible/board-certified cardiologists Congenital cardiac surgeons Nurses/physician assistants/nurse practitioners Cardiac anesthesiologists with CHD training/expertise Multidisciplinary teams: High-risk obstetrics Pulmonary hypertension HF/transplant Genetics Hepatology Cardiac pathology Rehabilitation services Social services Psychological services Financial counselors Services Echocardiography, including TEE and intraoperative TEE* CHD diagnostic and interventional catheterization* CHD electrophysiology/pacing/ICD implantation*: Exercise testing Echocardiographic Radionuclide Cardiopulmonary Cardiac imaging/radiology*: CMR CCT Nuclear medicine Information technology: Data collection Database support Quality assessment review/protocols *These modalities must be supervised/performed and interpreted by clinicians with expertise and/or training in CHD. 