Self-Efficacy and Physical Activity Level Holds Important Implications for Transfer of Adult Congenital Heart Disease

patients, a lack of experience with older CHD patients and because transfers from pediatric departments are not standard in Japan.2,3ACHD patients generally experience similar symptoms regardless of the underlying anatomy.Patient-reported outcomes (PROs)-related symptoms of greatest importance to ACDH patients are increasingly valued in addition to traditional medical parameters.PROs are directly reported by patients, without interference of the attending physician.PROs thus offer unique insight into how patients sense and judge their health and wellbeing.Thus we read with interest the article in this issue of the Journal investigating PROs in ACHD by Ochiai and colleagues 4 about the preferences C ongenital heart disease (CHD) affects close to 1% of live births.Surgical advances and improvement in medical care have significantly reduced early mortality and led to an exponential growth of the adult CHD (ACHD) population.As a result, Japan has approximately 400,000 ACHD patients, 130,000 of whom are estimated to be moderate or severe; this number is estimated to increase by 9,000 annually.However, many patients currently continue treatment with pediatric cardiologists, even after reaching adulthood, which stems from the inadequacy of regional ACHD centers, particularly adult cardiologists' passive attitudes toward ACHD care, and the lack of a cooperative network between regional ACHD centers and children's hospitals.1 Therefore, the number of regional centers offering outpatient and inpatient care is limited by a reluctance to deal with low numbers of Article p 824The opinions expressed in this article are not necessarily those of the editors or of the Japanese Circulation Society.