In the paper ‘Adult Congenital Heart Disease as a Career? Examining Encouraging and Deterring Factors in the Global ACHD Survey’, Bravo-Jaimes et al. present the results of a survey conducted among both ACHD and non-ACHD cardiologists and trainees, regarding their views on the factors that motivate or discourage pursuing a career dedicated to the care of adult congenital heart disease (ACHD) patients, aiming to elucidate which factors are the most attractive or deterrent(1).

This article does not directly address mortality, morbidity, epidemiology, or patients’ outcomes, but rather focuses on professionals. It is important to remember that expert care of ACHD patients has prognostic implications(2), making it highly relevant to understand the reasons underlying the well-known shortage of ACHD specialist professionals in various healthcare systems, despite an ever-increasing demand.
After conducting an anonymous survey via email and social media, the authors obtained analysable responses from 811 individuals, of whom 21% were dedicated to ACHD as a career and 79% were not. Respondents were categorised into two groups: ACHD cardiologists (with and without formal training) and non-ACHD cardiologists, with an additional classification by region of practice - North America (42.7%), Central and South America (18.4%), Europe (17.3%), Asia (15.9%), Africa (4.7%), and Oceania (1.1%). The main encouraging factors identified included awareness of ACHD significance, mentor influence, and clinical exposure, while the key deterrents were inadequate financial incentives, limited job opportunities, and lengthy training. The article also discusses some of the open-ended responses from survey participants, in which many of us working in the field of ACHD will likely see ourselves reflected.

Although the age ranges of survey participants are mentioned, the results have not been broken down by generation. It would be interesting to know the different motivations according to the professionals’ career stage.

While the authors acknowledge as a limitation the qualitative nature of their study and its reliance on a voluntary survey, the work is nonetheless of great value and joins other interesting initiatives such as multicentre surveys of patients on various aspects of their care and understanding of their condition(3), and can be considered within a more holistic approach to congenital heart disease (4).
One of the study's strengths is its global scope, with representation—albeit to varying degrees—from all five continents, each with their own healthcare systems and socioeconomic context. In addition to highlighting the lack of formal training in many regions as previously published (5), the differences in motivation between regions are particularly interesting. For example, a lack of awareness or understanding of ACHD as a specialty is a much more significant factor in Central and South America, Oceania, Africa, and Asia compared to North America and Europe, as are regional differences in concerns about the emotional and psychological challenges associated with ACHD care.

Finally, based on the results regarding professionals’ motivations, the article proposes measures to increase engagement in the ACHD field. The solutions proposed by Bravo-Jaimes et al. could likely be grouped under increasing awareness in this field, including advocating for structured and recognised training at both professional and economic levels, proportionate to the complexity of the work and the time required for adequate training, and with access possible from all regions. High-quality research in this field should also be promoted and disseminated. To achieve this, awareness should be raised among patients, professionals, scientific societies, industry, and governments at a global level.