A National Survey of Cardiologists on Scope of Practice, Knowledge Gaps, and Educational Priorities in Adult Congenital Heart Disease Care in Canada

Background

The increasing number of people with adult congenital heart disease (ACHD) leads to greater involvement of non-ACHD cardiologists in their care. Defining and supporting the educational priorities of non-ACHD cardiologists is key to ensure care of this population.

Methods

Between November 2023 and March 2024, Canadian cardiologists were invited to participate via email and the Canadian Cardiology Society bulletin. They self-identified as ACHD or non-ACHD cardiologists. The survey explored (1) self-identified knowledge gaps of non-ACHD cardiologists, (2) current scope of practice of non-ACHD cardiologists, and (3) ACHD perspectives on the recommended scope of practice of non-ACHD cardiologists. Educational priorities were defined as diagnoses or topics frequently identified as self-identified knowledge gaps or in the current or recommended scope of practice.

Results

A total of 133 of 1263 Canadian Cardiology Society members participated, of whom 32 were ACHD specialists. Thirty-three percent of non-ACHD cardiologists did not have an ACHD specialist on-site, and 24% indicated that there was no ACHD specialist within 100 km. Non-ACHD cardiologists encountered patients with ACHD in the inpatient (42%) and outpatient settings (42%), whereas ACHD cardiologists predominantly encountered outpatients (81%). Frequent self-identified knowledge gaps included great complexity diagnoses and management of pregnancy, arrhythmias, and heart failure. Recommended and current scope of practice involved simple and moderate diagnoses.

Conclusions

Targeted educational resources for non-ACHD cardiologists should initially focus on the identified educational priorities, including simple and some moderate diagnoses, a primer on great complexity diagnoses, acute management of heart failure and arrhythmias, and a primer on pregnancy in patients with ACHD.