Transition practices from paediatric to adult congenital heart disease care in central and south-eastern european countries

Background International societies recommend a structured transition process for patients with congenital heart disease (CHD) to ensure continuity of lifelong cardiac care. While many Western European countries have established formal transition programmes, data on current practices in Central and South-Eastern European (CESEE) countries remain limited. Purpose To characterize current transition practices from paediatric to adult congenital heart disease (ACHD) care across CESEE countries. Methods We conducted a descriptive cross-sectional survey of paediatric CHD and ACHD centres in 21 CESEE countries. The survey assessed transition practices (preparation, transfer), available resources, specialist involvement, and perceived barriers to implementation. Data were analysed using descriptive statistics. Results A total of 60 healthcare professionals from 43 institutions across 31 cities in 21 countries responded. An ACHD centre was reported in 29 of 43 institutions (67%); among these, 21 (72%) were established after 2000. Most ACHD centres (20/29, 69%) have < 3,000 patients under their care. Only 10/43 centres (23%) reported having a formal transition program. Among these, transition counselling most commonly consisted of a single, on-site, individual session conducted jointly by paediatric and adult cardiology teams (60%). Transition counselling was carried out mainly by an ACHD or paediatric CHD specialist, while psychologists or social workers were available in 20% of the transition programs. Transfer to adult care most frequently occurred between 18 and 20 years of age. Among institutions without a formal transition program, transition preparation was informal, typically provided either at the final paediatric visit or at the first ACHD consultation. In these centres, approximately half of patients self-referred to the ACHD service. The principal barriers to establishing structured transition programs were lack of adequately trained staff and financial constraints. Conclusions Fewer than one-quarter of surveyed CHD centres in CESEE countries have a formal transition program. Transition practices are largely informal, with substantial variability across institutions. Increased financial investment, workforce training, and policy-level support are needed to implement structured transition pathways and optimise continuity of care for adolescents with CHD.