Developmental Systems Cardiology: A Longitudinal Adaptive Framework for Congenital Heart Disease.

Area of Science:

• Pediatric Cardiology
• Developmental Pediatrics
• Health Systems Science

Background:

• Survival rates for congenital heart disease (CHD) have improved significantly due to medical advancements.
• Contemporary challenges in CHD extend beyond procedural success, encompassing neurodevelopmental, psychosocial, and lifelong adaptation needs.
• Social determinants of health and healthcare access significantly influence long-term CHD outcomes.

Purpose of the Study:

• To introduce Developmental Systems Cardiology (DSC) as an integrative framework for lifelong CHD care.
• To explore how DSC can inform various aspects of care, including neurodevelopmental support, psychosocial care, and healthcare transitions.
• To emphasize adaptation as a key outcome and organizing principle in managing CHD across the lifespan.

Main Methods:

• Conceptual framework development: Developmental Systems Cardiology (DSC).
• Literature synthesis on challenges and influences in lifelong CHD care.
• Exploration of DSC's application to clinical practice, implementation science, and professional formation.

Main Results:

• DSC conceptualizes CHD as a lifelong adaptive process influenced by biological, developmental, psychosocial, community, and healthcare factors.
• The framework highlights the impact of organizational factors, implementation, and health inequities on long-term outcomes.
• DSC provides a model for enhancing neurodevelopmental surveillance, psychosocial support, and coordinated transition medicine.

Conclusions:

• Future progress in CHD requires strengthening developmental, relational, educational, community, and organizational support systems.
• Adaptation is proposed as a central clinical outcome and implementation target within the DSC framework.
• DSC promotes integrated, lifespan care for individuals with CHD, particularly those with complex conditions like Fontan circulation.