Management of Women With Acquired Cardiovascular Disease From Pre-Conception Through Pregnancy and Postpartum

Park, Ki; Merz, C. Noel Bairey; Bello, Natalie A.; Davis, Melinda B.; Duvernoy, Claire S.; Elgendy, Islam Y.; Ferdinand, Keith C.; Hameed, Afshan B.; Itchhaporia, Dipti; Minissian, Margo; Reynolds, Harmony R.; Mehta, Puja K.; Russo, Andrea M.; Shah, Rashmee U.; Volgman, Annabelle Santos; Wei, Janet; Wenger, Nanette K.; Pepine, Carl J.; Lindley, Kathryn J.

doi:10.1016/j.jacc.2021.01.057

Cited by 42 publications

(31 citation statements)

References 45 publications

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“…These inconsistencies are particularly important given the recommendations for preconception counseling for women with underlying CVD and the growing recognition that the postpartum period is a high‐risk time for cardiovascular morbidity and mortality. 10 , 11 , 12 , 18 …”

Section: Discussionmentioning

confidence: 99%

“…CVT members have the potential to make important contributions to the cardio‐obstetrics care team, particularly during the fourth trimester when cardiovascular complications are common and long‐term risk modification and counseling is essential. 10 , 11 , 12 , 13 , 14 , 19 , 20 Future opportunities for the use of CVT members as part of the cardio‐obstetrics team include telehealth and remote vital sign monitoring. With proven efficacy, validity, and improved patient satisfaction, CVT telehealth visits and remote monitoring lead to increased compliance with recommendations and follow‐up for all demographics of women.…”

Section: Discussionmentioning

confidence: 99%

“…The care of pregnant women with or at risk for CVD covers a wide clinical spectrum, including preconception counseling, management of CVD during pregnancy and postpartum, and counseling and preventative care for women with a history of adverse pregnancy outcomes who are at heightened risk for subsequent CVD. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 To address the complexities of providing care to these pregnant women, comprehensive cardio‐obstetrics team‐based approaches have been developed at several centers. 15 , 16 , 17 Despite the field’s existence for several decades and a growing evidence base to guide the care of patients, 10 , 11 , 12 , 13 , 14 , 16 the current state of cardio‐obstetrics knowledge and practices of cardiologists, fellows in training (FITs), and cardiovascular team (CVT) members, as well as the prevalence and composition of formal cardio‐obstetrics programs, is unknown.…”

mentioning

confidence: 99%

“… 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 To address the complexities of providing care to these pregnant women, comprehensive cardio‐obstetrics team‐based approaches have been developed at several centers. 15 , 16 , 17 Despite the field’s existence for several decades and a growing evidence base to guide the care of patients, 10 , 11 , 12 , 13 , 14 , 16 the current state of cardio‐obstetrics knowledge and practices of cardiologists, fellows in training (FITs), and cardiovascular team (CVT) members, as well as the prevalence and composition of formal cardio‐obstetrics programs, is unknown. To answer these questions, we performed a cross‐sectional survey with a deliberate sampling design to provide results that are representative of the US membership of the American College of Cardiology (ACC).…”

mentioning

confidence: 99%

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Need for Better and Broader Training in Cardio‐Obstetrics: A National Survey of Cardiologists, Cardiovascular Team Members, and Cardiology Fellows in Training

Bello

Agrawal

Davis

et al. 2022

JAHA

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Background Team‐based models of cardio‐obstetrics care have been developed to address the increasing rate of maternal mortality from cardiovascular diseases. Cardiovascular clinician and trainee knowledge and comfort with this topic, and the extent of implementation of an interdisciplinary approach to cardio‐obstetrics, are unknown. Methods and Results We aimed to assess the current state of cardio‐obstetrics knowledge, practices, and services provided by US cardiovascular clinicians and trainees. A survey developed in conjunction with the American College of Cardiology was circulated to a representative sample of cardiologists (N=311), cardiovascular team members (N=51), and fellows in training (N=139) from June 18, 2020, to July 29, 2020. Knowledge and attitudes about the provision of cardiovascular care to pregnant patients and the prevalence and composition of cardio‐obstetrics teams were assessed. The widest knowledge gaps on the care of pregnant compared with nonpregnant patients were reported for medication safety (42%), acute coronary syndromes (39%), aortopathies (40%), and valvular heart disease (30%). Most respondents (76%) lack access to a dedicated cardio‐obstetrics team, and only 29% of practicing cardiologists received cardio‐obstetrics didactics during training. One third of fellows in training reported seeing pregnant women 0 to 1 time per year, and 12% of fellows in training report formal training in cardio‐obstetrics. Conclusions Formalized training in cardio‐obstetrics is uncommon, and limited access to multidisciplinary cardio‐obstetrics teams and large knowledge gaps exist among cardiovascular clinicians. Augmentation of cardio‐obstetrics education across career stages is needed to reduce these deficits. These survey results are an initial step toward developing a standard expectation for clinicians’ training in cardio‐obstetrics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Need for Better and Broader Training in Cardio‐Obstetrics: A National Survey of Cardiologists, Cardiovascular Team Members, and Cardiology Fellows in Training

Bello

Agrawal

Davis

et al. 2022

JAHA

Self Cite

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“…Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States [ 1 ]. Recent data suggest ischemic heart disease, which accounts for <2% of cardiovascular disease in pregnancy [ 2 , 3 ], and pregnancy-associated myocardial infarction (PAMI), are leading causes [ 1 , 2 , 3 , 4 ]. Acute coronary syndrome (ACS) is 3 to 4 times more likely to affect women during pregnancy than similarly aged, non-pregnant women [ 5 ], and is estimated to affect 3–10 of every 100,000 pregnancies [ 5 , 6 , 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Coronary Syndrome in Pregnancy and the Post-Partum Period

O’Kelly

Ludmir

Wood

2022

JCDD

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Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS.

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