{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:02:00Z","timestamp":1791223320328,"version":"4.1.0"},"reference-count":63,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,4,22]],"date-time":"2020-04-22T00:00:00Z","timestamp":1587513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. Med."],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Our understanding of the development of congenital heart disease (CHD) across the lifespan has evolved. These include the evidence for the change in demographics of CHD, the observations that lifelong complications of CHD result in CHD as a lifespan disease, and the concept of long windows of exposure to risk that start in foetal life and magnify the expression of risk in adulthood. These observations set the stage for trajectories as an emerging construct to target health\u2010service interventions. The lifelong cardiovascular and systemic complications of CHD make the long\u2010term care of these patients challenging for cardiologists and internists alike. A life\u2010course approach is thus required to facilitate our understanding of the natural history and to orient our clinical efforts. Three specific examples are illustrated: neurocognition; cancer resulting from exposure to low\u2010dose ionizing radiation; and cardiovascular disease acquired in ageing adults. As patients grow, they do not just want to live longer, they want to live well. With the need to move beyond the mortality outcome, a shift in paradigm is needed. A life\u2010course health development framework is developed for CHD. Trajectories are used as a complex construct to illustrate the patient\u2019s healthcare journey. There is a need to define disease trajectories, wellness trajectories and ageing trajectories in this population. Disease trajectories for repaired tetralogy of Fallot, transposition of the great arteries and the Fontan operation are hypothetically constructed. For clinicians, the life\u2010course horizon helps to frame the patient\u2019s history and plan for the future. For researchers, life\u2010course epidemiology offers a framework that will help increase the relevance of clinical enquiry and improve study design and analyses. A health\u2010service policy framework is proposed for a growing number of conditions that start in the before birth and extend as long as contemporary survival now permits. Ultimately, the goal is the precision delivery of health services that enables lifelong health management, organization of developmental health services, and integration of vertical and horizontal health\u2010service delivery.<\/jats:p>","DOI":"10.1111\/joim.13048","type":"journal-article","created":{"date-parts":[[2020,4,22]],"date-time":"2020-04-22T20:14:36Z","timestamp":1587586476000},"page":"390-399","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Trajectories of care in congenital heart disease \u2013 the long arm of disease in the womb"],"prefix":"10.1111","volume":"288","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1784-8206","authenticated-orcid":false,"given":"A.","family":"Marelli","sequence":"first","affiliation":[{"name":"McGill University Health Centre RVH\/Glen Site Cardiology McGill University Health Centre Montreal Qu\u00e9bec 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