Cardiological rehabilitation, prehabilitation, and cardiovascular prevention in adults with congenital heart defects: tasks and services of the German Pension Insurance—part 1: preventive cardiology and prehabilitation

Congenital heart defects (CHD) are the most common inborn cardiac anomalies, with approximately 1.35 million children born each year worldwide. Advances in medical treatment over recent decades have reduced mortality, yet morbidity remains high. Many patients now survive into adulthood but continue to have chronic heart disease and often develop complications such as heart failure, arrhythmias, pulmonary hypertension, and acquired cardiac and non-cardiac comorbidities, all of which require ongoing specialized care. Additionally, many adults with CHD (ACHD) lead a sedentary lifestyle, are overweight, and experience mental health issues, further affecting their well-being and quality of life. In this context, preventive, prehabilitative, and rehabilitative measures play an important role in reducing cardiovascular risks and enhancing overall quality of life. Preventive strategies aim to improve physical fitness, address health risks early, and support long-term well-being. Prehabilitation involves a structured, multimodal approach designed to strengthen physical and psychological resilience before planned medical interventions, thereby reducing complications and recovery times. Rehabilitation, on the other hand, facilitates recovery after treatment and promotes sustained health improvements over time. The German Pension Insurance provides programs aimed at enhancing physical fitness, promoting mental well-being, and improving quality of life, with a focus on maintaining employability and supporting occupational reintegration. However, available offerings are often not tailored to the specific needs of the heterogenous group of ACHD, limiting their potential effectiveness. The present article highlights the importance of cardiological prevention and prehabilitation in ACHD, focusing on the role of the German Pension Insurance system in helping affected adults remain employed and improve their quality of life. It explores how services can be better adapted to their needs and suggests that tailored programs, interdisciplinary collaboration, and ongoing research are essential for improving long-term outcomes in ACHD.