Preferences Regarding Transfer of Patients With Congenital Heart Disease Who Attend Children’s Hospital

centers with ACHD cardiologists, adult cardiologists, pediatric cardiologists, cardiac surgeons, and other related health-care providers with a wealth of experience of ACHD care and who are capable of meeting all potential needs of ACHD patients over their lifetime.A Canadian survey in 2014 indicated that the referral rate of patients to specialized ACHD centers increased after these guidelines were published and that specialized ACHD care was significantly related to reduced mortality.5 In Japan, the number of specialized ACHD centers has been rapidly increasing over the past decade.In Europe and North America, specialized ACHD centers were established under the direction of ACHD cardiologists with an adult cardiology background from the 1950 s onwards.6 In contrast, most Japanese CHD patients continue to receive follow-up by their pediatrician even after entering adulthood.For this reason, establishment of multidisciplinary approach-based specialized ACHD centers in Japan has A dvances in medical treatment, cardiac surgery, and other invasive and non-invasive medical care over the last several decades have led to enormous growth in the number of adults with congenital heart disease (CHD) throughout the world.In Japan, as of 2011, it was estimated that there were at least 400,000 adult CHD (ACHD) patients; this number was expected to increase by approximately 9,000 patients annually.1 Consequently, the number of ACHD patients in Japan in 2018 approaches 500,000.Many ACHD patients have residua and sequelae, and therefore need lifelong medical care including surgery and catheter intervention.They also experience unique issues in adulthood, such as lifestyle disease, pregnancy, childbirth, and mental health issues.Accordingly, they need multidisciplinary medical care.A specialized ACHD center, also called a regional ACHD center or a specialist center, is expected to play a central role in coordination of the ACHD care delivery system. 2-4The guidelines in Europe and North America call for 1 specialized ACHD center per 3-10 million people.2-4 Specialized ACHD centers are large, multidisciplinary