1
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Herrera CJ, Mateo J, Goldberg R, Romero LM, Henríquez PM, Cruz LJ, Pimentel C, Lorenzatti AJ, Higa CC, Saldarriaga CI, Múnera Echeverri AG, Escudero X, Rivas Estany E, Cornejo JA, Avilés EO, Rossel VA, Piña-Santana P, Harrington CM. Cardio-Obstetrics Practice in Latin America: A Regional Survey of General Cardiologists. JACC. ADVANCES 2024; 3:101295. [PMID: 39817095 PMCID: PMC11733958 DOI: 10.1016/j.jacadv.2024.101295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 01/18/2025]
Abstract
Background Cardiovascular (CV) disease is a leading cause of death in pregnant women globally, especially in low- and middle-income countries including Latin America (LATAM), where there is lack of data on how cardiologists are trained in cardio-obstetrics (CO) and the practice patterns in the care of pregnant patients. Objectives The authors aimed to identify CO competency and practice patterns among LATAM general cardiologists. Methods An anonymous cross-sectional Google-based electronic survey was sent via email to clinical cardiologists through local American College of Cardiology chapters and CV societies. Demographics, prior CO training, and practice patterns related to pregnant patients with CV disease were assessed. Results A total of 464 participants responded: 53% male, 52.5% from Central America and the Caribbean, 36.5% from South America, and 11% from Mexico. Most (67%) had not received didactic education in CO during fellowship; the majority expressed interest in participation in educational activities on this field, and only 18% reported practicing in centers equipped with CO teams or experts. Specific characteristics of CO practices in the region are shown in the figures. Conclusions Based on this survey, the CV care and follow-up of pregnant patients in LATAM is suboptimal; most cardiologists report lack of CO formal education during training and feel uncomfortable providing care during pregnancy although expressed interest in enhancing their knowledge in this field.
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Affiliation(s)
- César J. Herrera
- CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
| | - Jenniffer Mateo
- CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
| | | | | | - Pura M. Henríquez
- Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic
| | | | | | | | | | | | | | | | | | | | - Edgar O. Avilés
- Centro Médico Integral Alta Especialidad, Ciudad de Panamá, Panamá
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2
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Saxon CE, Bast J, Chou JC. Short and long-term complications of hypertensive disorders of pregnancy: lifelong cardiovascular risks we cannot ignore. Curr Opin Cardiol 2024; 39:259-265. [PMID: 38386339 DOI: 10.1097/hco.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy (HDP) pose a significant threat to maternal cardiovascular health, with emerging research shedding light on the enduring risks beyond the gestational period. This review highlights updates regarding cardiovascular risks associated with HDP and their implications for long-term health. RECENT FINDINGS Patients with a history of HDP are at an elevated risk of developing chronic hypertension, ischemic heart disease, stroke, valvular heart disease, and heart failure.Not surprisingly, patients with HDP experience higher rates of maternal and fetal adverse events in the antepartum and immediate postpartum periods, with high readmission rates for cardiovascular complications. The high risk of chronic hypertension after a HDP then leads to the development of subclinical disease over 5-10 years with overt cardiovascular disease becoming most prevalent in the decades following pregnancy. Early hypertension management in the antepartum and postpartum periods has lifelong health benefits and highlights the need for seamless postpartum transitions with close blood pressure monitoring and cardiovascular risk mitigation. SUMMARY HDP significantly increases the risk of short and long-term adverse cardiovascular events. Integrated healthcare models that assess and address postpartum cardiovascular risk are necessary to improve the cardiovascular health and longevity of those effected by HDP.
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Affiliation(s)
| | - Julia Bast
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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3
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Avila WS, Lucena AJGD. Cardio-Obstetrics: A Critical, Growing Subspecialty. Arq Bras Cardiol 2024; 121:e20230433. [PMID: 38597533 DOI: 10.36660/abc.20230433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/05/2023] [Indexed: 04/11/2024] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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4
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McCoy JA, Kim YY, Nyman A, Levine LD. Pregnancy-related cardiac outcomes among patients with congenital heart disease after formalization of a cardio-obstetrics program. Am J Obstet Gynecol MFM 2024; 6:101335. [PMID: 38460824 PMCID: PMC11081825 DOI: 10.1016/j.ajogmf.2024.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The prevalence of pregnant patients with congenital heart disease (CHD) is increasing, and these patients are at high risk for cardiac morbidity. OBJECTIVE This study aimed to examine the pregnancy outcomes in patients with congenital heart disease before and after the establishment of formal cardio-obstetrics collaboration between adult congenital heart disease and maternal-fetal medicine programs. STUDY DESIGN This was a retrospective cohort study of pregnant patients with congenital heart disease from 2002 to 2020 at a single urban academic institution in the United States. This study included patients with a singleton pregnancy who continued a pregnancy beyond 20 weeks of gestation. The primary outcome was a composite adverse maternal cardiac outcome, compared before (2002-2010) and after (2011-2020) the program. The secondary outcomes included gestational age at delivery, mode of delivery, rate of labor induction, use of diuresis after delivery, and a composite maternal morbidity outcome. RESULTS The number of pregnant patients with congenital heart disease increased after formalization of the cardio-obstetrics program (200 [postprogram group] vs 84 [preprogram group]; 0.48% of all deliveries in the postprogram group vs 0.25% of all deliveries in the preprogram group; P<.001). The postprogram group was more likely to undergo labor induction than the preprogram group (126 [63%] vs 34 [41%], respectively; P<.001). There were fewer patients in the postprogram group than in the preprogram group who were New York Heart Association class II to IV (23 [12%] vs 17 [22%], respectively; P=.04) or with systemic ventricular dysfunction (8 [4%] vs 12 [16%], respectively; P=.001). There was no difference in the primary outcome (38 [19%] in the postprogram group vs 14 [17%] in the preprogram group; P=.64), even after adjusting for confounders, including New York Heart Association class >I and systemic ventricular dysfunction (adjusted odds ratio, 2.3; 95% confidence interval, 0.96-5.4). Patients in the postprogram group were more likely to receive diuresis after delivery than patients in the preprogram group, even in the absence of heart failure or pulmonary edema (9 [4.5%] vs 0 [0.0%], respectively; P=.04). CONCLUSION In the period after the establishment of a formal cardio-obstetrics program between adult congenital heart disease and maternal-fetal medicine, the number of patients with congenital heart disease delivering at our institution increased significantly. Overall, fewer patients entered pregnancy with advanced-stage heart failure or systemic ventricular dysfunction, possibly suggesting improved prepregnancy cardiac care or improved preconception counseling. Composite maternal cardiac outcomes were similar, but the rates of postpartum diuresis increased significantly, suggesting increased attention to volume status in the postpartum period. Formalized collaboration between congenital heart disease and maternal-fetal medicine may help better optimize patients' care before conception, during pregnancy, and after delivery.
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MESH Headings
- Humans
- Female
- Pregnancy
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/complications
- Retrospective Studies
- Adult
- Pregnancy Outcome/epidemiology
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/therapy
- Gestational Age
- Labor, Induced/statistics & numerical data
- Labor, Induced/methods
- United States/epidemiology
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Cohort Studies
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Affiliation(s)
- Jennifer A McCoy
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs McCoy and Levine).
| | - Yuli Y Kim
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Kim); Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Kim and Ms Nyman)
| | - Annique Nyman
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Kim and Ms Nyman)
| | - Lisa D Levine
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs McCoy and Levine)
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5
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Blissett S, Skinner J, Banner H, Cristancho S, Taylor T. How do residents respond to uncertainty with peers and supervisors in multidisciplinary teams? Insights from simulations with epistemic fidelity. Adv Simul (Lond) 2024; 9:8. [PMID: 38347654 PMCID: PMC10863229 DOI: 10.1186/s41077-024-00281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Residents struggle to express clinical uncertainty, often exhibiting negative cognitive, behavioral, and emotional responses to uncertainty when engaging with patients or supervisors. However, the Integrative Model of Uncertainty Tolerance posits that individuals may have positive or negative responses to perceived uncertainty. Situational characteristics, such as interactions with other health professionals, can impact whether the response is positive or negative. The team context in which residents interact with resident peers and supervisors could represent varying situational characteristics that enable a spectrum of responses to uncertainty. Understanding the situational characteristics of multidisciplinary teams that allow residents to display positive responses to perceived uncertainty could inform strategies to foster positive responses to uncertainty in other contexts. We explored resident responses to perceived uncertainty in a simulated multidisciplinary team context. METHODS A simulation-primed qualitative inquiry approach was used. Fourteen residents from Cardiology and Obstetrics and Gynecology participated in simulation scenarios involving pregnant patients with heart disease. We incorporated epistemic fidelity through the deliberate inclusion of ambiguity and complexity to prompt uncertainty. Audio recordings of debriefing sessions were analyzed using directed content analysis. RESULTS Residents recognized that uncertainty is unavoidable, and positive responses to uncertainty are crucial to team dynamics and patient safety. While residents had positive responses to expressing uncertainty to peers, they had predominantly negative responses to expressing uncertainty to supervisors. Predominant negative response to supervisors related to judgement from supervisors, and impacts on perceived trustworthiness or independence. Although residents recognized expressing uncertainty to a supervisor could identify opportunities for learning and resolve their uncertainty, the negative responses overshadowed the positive responses. Residents highly valued instances in which supervisors were forthcoming about their own uncertainty. CONCLUSIONS Through participation in simulations with epistemic fidelity, residents reflected on how they perceive and respond to uncertainty in multidisciplinary teams. Our findings emphasize the role of situational characteristics, particularly peers and supervisors, in moderating responses to perceived uncertainty. The productive discussions around responses to uncertainty in debriefing sessions suggest further studies of multidisciplinary simulations could enhance our understanding of how uncertainty is expressed, and potentially be used as an instructional intervention to promote positive responses to uncertainty.
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Affiliation(s)
- Sarah Blissett
- Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Jamila Skinner
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Harrison Banner
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Sayra Cristancho
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Taryn Taylor
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON, Canada
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6
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Blissett S, Alphonsus L, Eastabrook G, Banner H, Siu SC. Designing a Multidisciplinary Cardio-obstetrics Curriculum for General Cardiology and Obstetrics Residents: A National Survey of Educational Needs. CJC Open 2024; 6:174-181. [PMID: 38487046 PMCID: PMC10935673 DOI: 10.1016/j.cjco.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/10/2023] [Indexed: 03/17/2024] Open
Abstract
Background The increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and obstetrics and gynecology (OBGYN) residents, we need to define educational needs from the perspectives of both cardiology and OBGYN residents. Our study characterizes the educational needs of Canadian cardiology and OBGYN residents. Methods Canadian cardiology and OBGYN residents were surveyed on clinical exposures, perceived needs for topics, unperceived needs for topics (multiple-choice questions) and preferences for educational formats. High priorities were defined as ≥ 50% of responses indicating a perceived need or ≥ 50% indicating an unperceived need. Results A total of 154 residents participated (cardiology n = 44, OBGYN n = 110). Residents reported insufficient clinical exposure to nearly all cardiac disorders, with 33% of exposures occurring in multidisciplinary contexts. All topics aside from gestational hypertension were rated as high priority on perceived needs by both specialties. High-priority unperceived needs were congenital heart disease (both specialties), pre-existing acquired heart disease (both specialties), medication safety (OBGYN), peripartum management (OBGYN), and pregnancy-related heart disease (OBGYN). Cardiology and OBGYN residents shared preferences for in-person simulation, virtual simulation, and online modules. Conclusions Residents in both specialties reported low clinical exposure to most cardiac disorders during pregnancy, identified high-priority perceived needs in multiple topics, and shared 2 high-priority unperceived needs. OBGYN residents identified 3 additional high-priority unperceived needs. These data can inform design of multidisciplinary cardio-obstetrics curricula for general cardiology and OBGYN residents.
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Affiliation(s)
- Sarah Blissett
- Department of Medicine, Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Lotus Alphonsus
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Genevieve Eastabrook
- Department of Obstetrics and Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Harrison Banner
- Department of Obstetrics and Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Samuel C. Siu
- Department of Medicine, Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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7
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Sarma AA, Lau ES, Sharma G, King LP, Economy KE, Wood R, Wood MJ, Feinberg L, Isselbacher EM, Hameed AB, DeFaria Yeh D, Scott NS. Maternal Cardiovascular Health Post-Dobbs. NEJM EVIDENCE 2024; 3:EVIDra2300273. [PMID: 38320493 DOI: 10.1056/evidra2300273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Maternal Cardiovascular Health Post-DobbsPregnancy is associated with increasing morbidity and mortality in the United States. In the post-Dobbs era, many pregnant patients at highest risk no longer have access to abortion, which has been a crucial component of standard medical care.
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Affiliation(s)
- Amy A Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA
| | - Louise P King
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Rachel Wood
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Loryn Feinberg
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston
| | | | | | | | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Boston
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8
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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9
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Skowronski J. Pregnancy and Heart Failure: This Is Our Lane. J Card Fail 2023; 29:1689-1691. [PMID: 37944789 DOI: 10.1016/j.cardfail.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
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10
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Rao SJ, Kwapong YA, Boakye E, Mallya P, Zhao J, Akel W, Hong H, Li S, Oyeka CP, Metlock FE, Ouyang P, Blumenthal RS, Nasir K, Khandelwal A, Kinzy C, Mehta LS, Roger VL, Hall JL, Sharma G. Reproductive Experiences and Cardiovascular Disease Care in Pregnancy-Capable and Postmenopausal Individuals: Insights From the American Heart Association Research Goes Red Registry. Curr Probl Cardiol 2023; 48:101853. [PMID: 37302649 PMCID: PMC10710519 DOI: 10.1016/j.cpcardiol.2023.101853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
To evaluate preconception health and adverse pregnancy outcome (APO) awareness in a large population-based registry. We examined data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry to questions regarding prenatal health care experiences, postpartum health, and awareness of the association of APOs with cardiovascular disease (CVD) risk. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk, significantly varying by race-ethnicity. Fifty-nine percent of participants were not educated regarding this association by their providers, and 37% reported providers not assessing pregnancy history during current visits, significantly varying by race-ethnicity, income, and access to care. Only 37.1% of respondents were aware that CVD was the leading cause of maternal mortality. There is an urgent, ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.
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Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | - Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ellen Boakye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Juan Zhao
- American Heart Association, Dallas, TX
| | | | | | - Shen Li
- American Heart Association, Dallas, TX
| | - Chigolum P Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Abha Khandelwal
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | | | - Laxmi S Mehta
- Division of Cardiology, The Ohio State University, Columbus, OH
| | - Veronique L Roger
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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11
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Skinner JY, Banner H, Cristancho S, Siu S, Blissett S. The role of multidisciplinary simulations in cardio-obstetrics education: perspectives from simulated hemodynamically unstable patients. Am J Obstet Gynecol MFM 2023; 5:101052. [PMID: 37321540 DOI: 10.1016/j.ajogmf.2023.101052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Jamila Y Skinner
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Harrison Banner
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sayra Cristancho
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Samuel Siu
- Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sarah Blissett
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, B6-117A, 339 Windermere Rd, London, Ontario N6A 5A5, Canada; Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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12
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Wolfe NK. We Can Do Better: Reproductive Health Counseling for Women with Congenital Heart Disease and Disabilities. J Womens Health (Larchmt) 2023; 32:734-735. [PMID: 36989513 DOI: 10.1089/jwh.2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Natasha K Wolfe
- Department of Internal Medicine and Pediatrics, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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13
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Rao SJ, Kwapong YA, Boakye E, Mallya P, Zhao J, Akel W, Hong H, Li S, Oyeka CP, Metlock FE, Ouyang P, Blumenthal RS, Nasir K, Khandelwal A, Kinzy C, Mehta LS, Roger VL, Hall JL, Sharma G. Reproductive Experiences and Cardiovascular Disease Care in Pregnancy Capable and Post-Menopausal Individuals: Insights from the American Heart Association Research Goes Red Registry. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.14.23287279. [PMID: 36993300 PMCID: PMC10055463 DOI: 10.1101/2023.03.14.23287279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Information on reproductive experiences and awareness of adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD) risk among pregnancy-capable and post-menopausal individuals has not been well described. We sought to evaluate preconception health and APO awareness in a large population-based registry. Methods Data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry (AHA-RGR) were used. Responses to questions pertaining to prenatal health care experiences, postpartum health, and awareness of the association of APOs with CVD risk were used. We summarized responses using proportions for the overall sample and by stratifications, and we tested differences using the Chi-squared test. Results Of 4,651individuals in the AHA-RGR registry, 3,176 were of reproductive age, and 1,475 were postmenopausal. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk. This varied by different racial/ethnic groups (non-Hispanic White: 38%, non-Hispanic Black: 29%, Asian: 18%, Hispanic: 41%, Other: 46%; P = 0.03). Fifty-nine percent of the participants were not educated regarding the association of APOs with long-term CVD risk by their providers. Thirty percent of the participants reported that their providers did not assess pregnancy history during current visits; this varied by race-ethnicity ( P = 0.02), income ( P = 0.01), and access to care ( P = 0.02). Only 37.1% of the respondents were aware that CVD was the leading cause of maternal mortality. Conclusions Considerable knowledge gaps exist in the association of APOs with CVD risk, with disparities by race/ethnicity, and most patients are not educated on this association by their health care professionals. There is an urgent and ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.
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Affiliation(s)
- Cornelia R Graves
- Collaborative Perinatal Cardiac Center St. Thomas Health Systems Nashville TN USA.,University of Tennessee Health Science Center-Nashville Ascension St. Thomas Midtown Hospital Nashville TN USA
| | - Ruth M Woldemichael
- University of Tennessee Health Science Center-Nashville Ascension St. Thomas Midtown Hospital Nashville TN USA
| | - Stacy F Davis
- Collaborative Perinatal Cardiac Center St. Thomas Health Systems Nashville TN USA.,St Thomas Midtown Comprehensive Heart Failure Center St. Thomas Health Systems Nashville TN USA
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Birru Talabi M, Callegari LS, Kazmerski TM, Krishnamurti T, Mosley EA, Borrero S. A blueprint for a new model of sexual and reproductive health care in subspecialty medicine. Health Serv Res 2023; 58:216-222. [PMID: 36151999 PMCID: PMC9836962 DOI: 10.1111/1475-6773.14074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mehret Birru Talabi
- Division of Rheumatology and Clinical ImmunologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Lisa S. Callegari
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Obstetrics and GynecologyUniversity of Washington School of MedicineSeattleWashingtonUSA
- Health Services Research and DevelopmentVA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Traci M. Kazmerski
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tamar Krishnamurti
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Elizabeth A. Mosley
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sonya Borrero
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Health Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
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Ivey SL, Hanley HR, Taylor C, Stock E, Vora N, Woo J, Johnson S, Bairey Merz CN. Early identification and treatment of women's cardiovascular risk factors prevents cardiovascular disease, saves lives, and protects future generations: Policy recommendations and take action plan utilizing policy levers. Clin Cardiol 2022; 45:1100-1106. [PMID: 36128629 DOI: 10.1002/clc.23921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular diseases (CVD) including heart attacks, strokes, heart failure, and uncontrolled hypertension are leading causes of death among women of all ages. Despite efforts to increase awareness about CVD among women, over the past decade there has been stagnation in the reduction of CVD in women, and CVD among younger women and women of color has in fact increased. We recommend taking action using policy levers to address CVD in women including: (1) Promoting periodic screening for risk factors including blood pressure, lipids/cholesterol, diabetes for all women starting at 18-21 years, with calculated atherosclerotic CVD (ASCVD) risk score use among women 40 years or older. (2) Considering coronary artery calcium (CAC) screening for those with intermediate risk per current guidelines. (3) Enhancing Obstetrics and Gynecology and primary care physician education on reproductive age CVD risk markers, and that follow-up is needed, including extended postpartum follow-up. (4) Offering Health Coaching/motivational Interviewing to support behavior change. (5) Funding demonstration projects using different care models. (6) Creating a Stop High Blood Pressure consult line (for providers and patients) and providing other support resources with actions consumers can take, modeled after the California tobacco quit line. And (7) Requiring inclusion of adverse pregnancy outcomes in all Electronic Health Records, with reminder systems to follow-up on hypertension post-partum.
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Affiliation(s)
- Susan L Ivey
- UC Berkeley, School of Public Health, Berkeley, California, USA
| | | | - Catrina Taylor
- California Department of Public Health, Sacramento, California, USA
| | - Eveline Stock
- UCSF, School of Medicine, Cardiology, San Francisco, California, USA
| | - Nirali Vora
- School of Medicine, Neurology, Stanford University, Stanford, California, USA
| | - Jenny Woo
- UC Berkeley, School of Public Health, Berkeley, California, USA
| | - Sara Johnson
- Obstetrics and Gynecology, Alta Bates Summit Medical Center, Berkeley, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
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