Key result
APP-led coordination overcomes socioeconomic barriers to preserve guideline-directed care in a Fontan patient.
Why the study?
Adults with Fontan circulation require lifelong specialized care, but social and financial barriers frequently interfere with guideline-directed management implementation.
Case Report (n=1)
Advanced practice providers in adult congenital heart disease programs can serve as a crucial clinical hub to identify and overcome social and financial barriers to care for patients with Fontan circulation.
Answers are grounded in this paper and cite their sources.
May support APP-led coordination to sustain guideline-directed care despite access barriers in Fontan patients; leaves open scalable implementation and outcomes.
TOPIC: Adults with Fontan circulation require lifelong specialized care, yet social and financial barriers frequently interfere with implementation of guideline-directed management. Advanced practice providers (APPs) practicing in adult congenital heart disease (ACHD) programs are uniquely positioned to identify these barriers through longitudinal relationships and coordinate multidisciplinary interventions that preserve continuity of care. DISCUSSION SUMMARY: An adult with Fontan circulation developed recurrent atrial fibrillation during prolonged insurance instability, resulting in medication rationing and delayed surveillance. Through routine clinic visits and scheduled longitudinal follow-up, the ACHD APP recognized that interrupted care reflected barriers to access rather than nonadherence. Coordination with electrophysiology, social work, legal advocacy, medication assistance programs, and ACHD physicians allowed the care team to individualize the timing of interventions while preserving guideline-directed management and continuity of specialty care. TAKE-HOME MESSAGES: Adults with Fontan circulation often require multidisciplinary solutions to overcome barriers to care. The ACHD APP can serve as the clinical hub that identifies barriers, coordinates resources, and helps sustain guideline-directed management.
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Stephens et al. (2026) conducted a case report in Fontan circulation with recurrent atrial fibrillation (n=1). Multidisciplinary coordination by an ACHD APP was evaluated. Multidisciplinary coordination led by an advanced practice provider helped overcome social and financial barriers to preserve guideline-directed management in an adult with Fontan circulation.
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