title: Meeting the challenge: the evolving global landscape of adult congenital heart disease.
abstract: BACKGROUND
  Only limited information is available on the worldwide distribution and volume of adult congenital heart disease (ACHD) centers. We aimed to assess the centers using a bibliometric approach.
  
  
  RESULTS
  We identified publications presenting original research in the field of ACHD between 1995 and 2011. A total of 94,119 articles were identified which underwent electronic filtering and manual review. Overall, a dramatic increase in ACHD publications was seen over the study period. This was accompanied by a matching increase in impact factors and an over-proportional rise in ACHD contributions relative to the general academic field. Research output correlated well with self-reported patient volume and the number of identified ACHD centers in Europe and North America was in agreement with published surveys, thus validating our methodology. We observed a steady increase in the number of publishing ACHD centers worldwide. The number of ACHD centers per 10-million population was highest for Europe (3.6), followed by North America (1.7), Oceania (1.5), South America (0.4), Asia (0.3) and Africa (0.1). In addition, we evaluated the relative research output between developed and emerging economies and provide an overview over the main areas of research in the ACHD field.
  
  
  CONCLUSIONS
  Global interest in ACHD is increasing and this is reflected, both, in the number of publishing centers and the volume of research. Our data provides insights into the geographical and temporal distribution of ACHD research over the last 1 1/2 decades. These results could serve as benchmarks for international comparisons and guide efforts for improving ACHD infrastructure.
authors: Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, UK. Electronic address: kempny@gmail.com.
authors: Aleksander
authors: A
authors: Kempny
authors: Rodrigo
authors: R
authors: Fernández-Jiménez
authors: Oktay
authors: O
authors: Tutarel
authors: Konstantinos
authors: K
authors: Dimopoulos
authors: Anselm
authors: A
authors: Uebing
authors: Yumi
authors: Y
authors: Shiina
authors: Rafael
authors: R
authors: Alonso-Gonzalez
authors: Wei
authors: W
authors: Li
authors: Lorna
authors: L
authors: Swan
authors: Helmut
authors: H
authors: Baumgartner
authors: Michael A
authors: MA
authors: Gatzoulis
authors: Gerhard-Paul
authors: GP
authors: Diller
mesh_terms: D000328:Adult; D015706:Bibliometrics; D035843:Biomedical Research / Q000639:trends*; D014943:Global Health / Q000639:trends*; D006291:Health Policy / Q000639:trends*; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D055811:Journal Impact Factor; D011643:Publishing / Q000706:statistics & numerical data*
keywords: Adult congenital heart disease; Health policy; Outcome