Delivery of Care Recommendations for Delivery of Care Referenced studies that support recommendations are summarized in Online Data Supplements 3, 4, and 5. COR LOE Recommendations I B-NR Patients with ACHD AP classification IB-D, IIA-D, and IIIA-D* should be managed in collaboration with an ACHD cardiologist.S3.3-1 I C-LD Cardiac surgery, catheter-based interventional cardiac procedures, and electrophysiological procedures involving congenital heart lesions in patients with ACHD should be performed by operators with expertise in CHD procedures and in collaboration with an ACHD *See Tables 3 and 4 for details on the ACHD Anatomic and Physiological classification system. Recommendation-Specific Supportive Text 1. Patients with ACHD, particularly those with more severe CHD, cared for in specialized centers have lower mortality than those managed without spe- Although clinical practice guide- lines can be helpful, many management decisions for patients with ACHD must be based on insuf- ficient data or care guidelines and require clinical experience often involving multiple members of an ACHD team. Patients with complex anatomic and physiological forms of ACHD may need approaches to evaluation and treatment that differ from those applicable to adults without ACHD who have valve disease, HF, or arrhythmias. From a practical perspective, it may be difficult to identify clinicians with expertise in ACHD, and expertise in ACHD varies across medical and sur- gical specialties. Some specialties, such as cardi- ology and congenital heart surgery, have defined ACHD fellowship training and board certification, whereas for others, ACHD expertise is gained by focused experience during training and practice. In 2012, the American Board of Medical Spe- cialties approved ACHD as a subspecialty of in- ternal medicine ( adult ) cardiology and pedi- atric cardiology. Therefore, for cardiologists, one marker of ACHD expertise is board eligibility/board certification in ACHD. 