Cardiological rehabilitation, prehabilitation, and cardiovascular prevention in adults with congenital heart defects: tasks and services of the German Pension Insurance-part 2: cardiological rehabilitation.

Congenital heart defects (CHD) represent the most common inborn organ anomaly, with more than a million newborns affected annually. Advances in diagnostics and treatment have led to significantly improved survival rates, resulting in a growing population of an estimated 50 million adults with congenital heart defects (ACHD) worldwide. As these individuals age, they often face a high burden of morbidity and complex long-term health challenges that require specialized, lifelong care. In this context, cardiological rehabilitation (CR) becomes increasingly important, not only to reduce morbidity but also to enhance patients' quality of life and support their social and occupational integration. While CR has been extensively studied and implemented for acquired heart diseases, structured rehabilitation programs tailored to the specific needs of ACHD remain limited in clinical practice and in the scientific literature. Globally, both the availability of CR and the presence of structured concepts vary widely. CR is predominantly offered in high-income countries, with Western Europe providing the most extensive services. In many low- and middle-income countries, access to CR remains limited or is sometimes not available at all. However, even in high-income settings, targeted ACHD programs are scarce, meaning that many ACHD are treated in general CR programs that do not adequately address the complexity of CHD. The present article outlines the core components of CR, provides recommendations on how these are implemented in current practice, identifies existing limitations, and discusses how services could be better aligned with the complex medical and psychosocial needs of ACHD. It also describes the role of the German Pension Insurance in funding and providing rehabilitation services in Germany. Tailored rehabilitation programs, greater integration of ACHD expertise, and targeted research are essential to improve long-term outcomes and establish patient-centered care structures for the growing ACHD population. In this way, the present paper is intended to support the development of rehabilitation programs for countries where such structures currently do not exist.