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Lee J, Howard KJ, Leong C, Grigsby TJ, Howard JT. Beyond Being Insured: Insurance Coverage Denial as a Major Barrier to Accessing Care During Pregnancy and Postpartum. Clin Nurs Res 2023; 32:1092-1103. [PMID: 37264856 PMCID: PMC10504817 DOI: 10.1177/10547738231177332] [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] [Indexed: 06/03/2023]
Abstract
This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March and April 2022 to women who were either pregnant or within 1 year postpartum (n = 1,113). The outcome was delayed care, measured at four time points: during pregnancy and 1 week, 2 to 6 weeks, and after 7 weeks postpartum. The key covariate was insurance coverage denial by providers during pregnancy. Delayed care due to having an unaccepted insurance and being "out-of-network" was more pronounced at 1 week postpartum with 3.37 times and 3.47 times greater odds and in 2 to 6 weeks postpartum with 5.74 times and 2.97 times greater odds, respectively. The association between insurance denial and delays in care encapsulated transportation, rural residency, time issues, and financial constraints. The findings suggest that coverage denial is associated with significant delays in care, providing practical implications for effective perinatal care.
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Patient-Perceived Satisfaction and Knowledge Uptake in a Combined Cardio-Obstetrics Clinic. J Cardiovasc Dev Dis 2022; 9:jcdd9120433. [PMID: 36547430 PMCID: PMC9781400 DOI: 10.3390/jcdd9120433] [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: 10/11/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Heart disease is the leading cause of pregnancy-related mortality in the United States and has led to the development of combined cardio-obstetrics (COB) clinics as a model for prenatal care. In other areas of medicine, these types of collaborative care models have shown improvement in morbidity, mortality, and patient satisfaction. There is some data to suggest that a combined COB clinic improves maternal outcomes but there is no data to suggest patients prefer this type of care model. This study aims to evaluate patient satisfaction in a combined COB clinic and whether this type of model enhances perceived communication and knowledge uptake. A quality questionnaire was developed to assess patient perceptions regarding communication, satisfaction, and perceived knowledge. Patients who attended the clinic (n = 960) from 2014-2020 were contacted by email, with a response received from 119 (12.5%). Participants completed a questionnaire assessing satisfaction and perceived knowledge uptake with answers based on a Likert scale (7 representing very satisfied and 1 representing very unsatisfied). Safe and effective contraceptive use was evaluated by multiple choice options. Knowledge was also assessed by comparing contraceptive use before and after the clinic. Participants reported high levels of satisfaction with the clinic (6.2 ± 1.5), provider-to-patient communication (6.1 ± 1.6), and with the multidisciplinary appointment approach (6.3 ± 1.5). As well, participants reported an increase in knowledge about heart disease a result of collaborative counseling. In summary, a multidisciplinary approach to cardio-obstetrics not only improves outcomes but is a patient satisfier.
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Liu E, Bigeh A, Ledingham L, Mehta L. Prevention of Coronary Artery Disease in Women. Curr Cardiol Rep 2022; 24:1041-1048. [PMID: 35699818 DOI: 10.1007/s11886-022-01721-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease remains the leading cause of morbidity and mortality in women. Women were historically underrepresented in landmark trials for which cardiovascular guidelines are based on and are prone to gender-specific risk factors that predispose to coronary heart disease. RECENT FINDINGS More attention has been made on gender and pregnancy-associated risk factors such as autoimmune disorders and preeclampsia. The most recent guidelines have reflected the need to consider risk-enhancing factors that are unaccounted for in traditional risk assessment tools. As the population ages and the burden of cardiovascular disease in women increases, it is crucial to continue focusing on preventative of cardiovascular disease in women.
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Affiliation(s)
- Ellen Liu
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Allison Bigeh
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Lauren Ledingham
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Laxmi Mehta
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
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Liu S, Zhang Q, Liu W, Zheng L, Zhou J, Huang X. Hereditary haemorrhagic telangiectasia with atrial septal defect and pulmonary hypertension during advanced pregnancy: a case report and literature review. J Int Med Res 2022; 50:3000605221085427. [PMID: 35380076 PMCID: PMC9052829 DOI: 10.1177/03000605221085427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pregnancy complicated with hereditary haemorrhagic telangiectasia (HHT) is a rare
condition. This case report presents an extremely rare case with the
co-occurrence of HHT and congenital heart disease. In this report, a 43-year-old
woman at 36 + 4 weeks of gestation experienced haemoptysis with a volume of
approximately 300 ml for the first time. Uncommonly, her transthoracic
echocardiogram revealed a previously unrecognized atrial septal defect (ASD) and
pulmonary hypertension (PH) for the first time at 36 + 1 weeks of gestation.
Chest computed tomography revealed an arteriovenous malformation (AVM) in the
right lower lobe of the lung. Due to concerns of rebleeding of ruptured
pulmonary arteriovenous malformations (PAVMs), the patient underwent a caesarean
section at 36 + 6 weeks of gestation. A healthy male infant weighing 2800 g was
delivered. To the best of our knowledge, there have been few reports about HHT
with ASDs and PH during advanced pregnancy. This current case report highlights
the necessity for clinicians to pay considerable attention to cardiac structural
abnormalities, which can worsen PAVM in patients with HHT during pregnancy, for
whom terminating the pregnancy in time may reduce the risk of PAVM rupture.
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Affiliation(s)
- Shouze Liu
- Department of Gynaecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Qianqian Zhang
- Department of Gynaecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Wenhua Liu
- Department of Pain, Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou, Hebei Province, China
| | - Lili Zheng
- Department of Gynaecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jingwen Zhou
- Department of Gynaecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xianghua Huang
- Department of Gynaecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Cupido B, Zühlke L, Osman A, van Dyk D, Sliwa K. Managing Rheumatic Heart Disease in Pregnancy: A Practical Evidence-Based Multidisciplinary Approach. Can J Cardiol 2021; 37:2045-2055. [PMID: 34571164 DOI: 10.1016/j.cjca.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022] Open
Abstract
Rheumatic heart disease (RHD) remains a leading cause of mortality and morbidity in pregnant patients in low- to middle-income countries. Apart from the clinical challenges, these areas face poor infrastructure and resources to allow for early detection, with many women presenting to medical services for the first time when they deteriorate clinically during the pregnancy. The opportunity for preconception counselling and planning may thus be lost. It is ideal for all women to be seen before conception and risk-stratified according to their clinical state and pathology. The role of the cardio-obstetrics team has emerged over the past decade with the aim of a seamless transition to and from the appropriate levels of care during pregnancy. Severe symptomatic mitral and aortic valve stenoses portend the greatest risk to both mother and fetus. In mitral stenosis, beta-blockers are the cornerstone of therapy and only a small number of patients require balloon valvuloplasty. Regurgitant lesions mostly require diuretics alone for the treatment of heart failure. The mode of delivery is usually vaginal; caesarean section is performed in those with obstetrical indications or in cases with severe stenosis and a poor clinical state. The postpartum period presents a second high-risk period for maternal adverse events, with heart failure and arrhythmias being the most frequent. This review aims to provide a practical evidence-based multi-disciplinary approach to the management of women with RHD in pregnancy.
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Affiliation(s)
- Blanche Cupido
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Liesl Zühlke
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; The Deanery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ayesha Osman
- Department of Obstetrics and Gynaecology: Maternal Fetal Medicine Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Dominique van Dyk
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
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