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. ACHD indicates adult congenital heart disease; CCT, cardiac computed tomography; CHD, congenital heart disease; CMR, cardiovascular magnetic resonance; HF, heart failure; ICD, implantable cardioverter-defibrillator; and TEE, transesophageal echocardiography. CLINICAL STATEMENTS AND GUIDELINES Different needs for evaluation and management compared with adults with acquired cardiovascular disease. Recommendation-Specific Supportive Text 1. Many patients with CHD face gaps in care during and after adolescence.S3.2-2 Common reasons include lack of knowledge regarding need for follow-up, in- ability to find specialized providers, insurance issues, and feeling well.S3.2-1 Patients with gaps in care are more likely to develop medical problems requir- ing intervention than those receiving continuous Canadian patients with CHD in special- ized care programs had lower mortality than those in centers without ACHD expertise.S3.2-5 Improving transition programs and recognizing the importance of long-term care will hopefully improve access to specialty care. Insurance barriers and lack of spe- cialty providers for the large number of patients are issues; thus, relationships with regulatory agencies to address these challenges are important. 3.3. Delivery of Care Recommendations for Delivery of Care Referenced studies that support recommendations are summarized in Online Data Supplements 3, 4, and 5. 