The crucial role of non-specialty local hospitals and clinics in managing advanced stages of adult congenital heart disease in an era of increasing prevalence.

A middle-aged woman with complex congenital heart disease (CHD) and stage D heart failure-including a double outlet univentricular heart-faced difficulty accessing a specialised centre due to dyspnoea, frailty and geographic distance. Despite attempting to seek care at local hospitals and clinics, she was turned away due to the absence of specialists in adult CHD (ACHD). Over time, our local tertiary care hospital, though lacking the expertise to care for her ACHD initially, coordinated a gradual transition of care from the ACHD centre to our facility by overlapping services and addressing both her medical and psychological needs. Ultimately, the care transition was successful. This case highlights the urgent need to establish integrated, community-based care models for adults with complex CHD, incorporating local hospitals, primary care providers, home health services and a structured consultation pathway with ACHD specialists. Without such systems, frail patients in advanced stages of CHD with severe complexity may be left without access to appropriate care.