Overcoming Social and Financial Barriers to Guideline-Directed Fontan Care

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.

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.

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.