Technology for better adult congenital heart disease care: the time is now

The growing population of patients with adult congenital heart disease (ACHD) present complex lifelong care needs that traditional health systems are struggling to meet. Without innovation, gaps in access, timeliness and specialist oversight will widen. Digital health technologies, including artificial intelligence (AI), telemedicine, wearable devices and interoperable platforms offer a unique opportunity to transform care, but their potential in ACHD remain underexplored.

AI-driven prediction models show encouraging performance in mortality and event risk but require external validation and lesion-specific adaptation. Telemedicine, accelerated during the COVID-19 pandemic, has demonstrated safety and high patient satisfaction in selected cohorts, yet robust hybrid pathways are lacking. Wearables can capture rhythm, oxygen saturations and activity in real time, but consumer devices remain poorly validated for complex ACHD physiology. Data integration frameworks, such as federated learning, demonstrate global feasibility but face challenges in governance and interoperability.

Progress in ACHD digital health will depend on three imperatives: (1) rigorous, prospective validation of digital tools in congenital populations; (2) equitable implementation, addressing digital literacy, infrastructure and reimbursement; (3) governance frameworks that embed specialist oversight, data privacy and cybersecurity from the outset.

Digital health is no longer optional in ACHD care. The field risks falling behind broader cardiovascular innovation unless patients, clinicians, technologists and policymakers commit to specialist-led integration. A decisive shift towards validated, equitable and interoperable solutions can transform ACHD management into a more predictive, personalised and preventive discipline. The aim of this viewpoint is to highlight how digital technologies could strengthen ACHD care and define priorities for future adoption.