The emerging burden of heart failure in adults with congenital heart disease

Ntiloudi et al. confirm the high burden of failure-related morbidity and mortality in adults with CHD. However, the pathways leading to heart failure in ACHD are heterogeneous and often poorly understood. Most importantly, there is a need for more randomized trials. Trials investigating effects on symptoms and surrogate measures of disease need not be large. However, much larger trials are required to investigate the effects of treatment on disease progression and prognosis, requiring collaborations at national and international levels, as is already the case for other forms of heart failure.