2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

Prevalence and Professional Impact of Mental Health Conditions Among Cardiologists

BACKGROUND

Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited.

OBJECTIVES

The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life.

METHODS

The American College of Cardiology conducted an online survey with 5,931 cardiologists globally in 2019. Data on demographics, practice, MHC, and association with professional activities were analyzed. The P values were calculated using the chi-square, Fischer exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with MHC.

RESULTS

Globally, 1 in 4 cardiologists experience any self-reported MHC, including psychological distress, or major or other psychiatric disorder. There is significant geographic variation in MHCs, with highest and lowest prevalences in South America (39.3%) and Asia (20.1%) (P < 0.001). Predictors of MHCs included experiencing emotional harassment (OR: 2.81; 95% CI: 2.46-3.20), discrimination (OR: 1.85; 95% CI: 1.61-2.12), being divorced (OR: 1.85; 95% CI: 1.27-2.36), and age <55 years (OR: 1.43; 95% CI: 1.24-1.66). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help (42.3% vs 31.1%) as compared with men (all P < 0.001). Nearly one-half of cardiologists reporting MHCs (44%) felt dissatisfied on at least one professional metric including feeling valued, treated fairly, and adequate compensation.

CONCLUSIONS

More than 1 in 4 cardiologists experience self-reported MHCs globally, and the association with adverse experiences in professional life is substantial. Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists.

Advancing Equity in Blood Pressure Control: A Response to the Surgeon General's Call-to-Action

Hypertension is an established risk factor for cardiovascular disease. Although controlling blood pressure reduces cardiovascular and stroke mortality and target organ damage, poor blood pressure control remains a clinical and public health challenge. Furthermore, racial and ethnic disparities in the outcomes of hypertension are well documented. In October of 2020, the U.S. Department of Health and Human Services published The Surgeon General's Call to Action to Control Hypertension. The Call to Action emphasized, among other priorities, the need to eliminate disparities in the treatment and control of high blood pressure and to address social determinants as root causes of inequities in blood pressure control and treatment. In support of the goals set in the Call to Action, this review summarizes contemporary research on racial, ethnic, and socioeconomic disparities in hypertension and blood pressure control; describes interventions and policies that have improved blood pressure control in minoritized populations by addressing the social determinants of health; and proposes next steps for achieving equity in hypertension and blood pressure control.

Women in Procedural Leadership Roles in Cardiology: The Women In Local Leadership (WILL) Observational Study

BACKGROUND

While 50% of U.S. medical students are women, this fails to translate to cardiology: gender disparities are striking in interventional cardiology (IC) and electrophysiology (EP) and in leadership. Left atrial appendage closure with the WATCHMAN device, as a novel procedure, is a lens into inequities.

OBJECTIVE

To identify characteristics and prevalence of women: 1) as early WATCHMAN implanters, and 2) in related leadership.

METHODS

Data was collected on WATCHMAN implanters and hospitals from January 2017-December 2018. The gender of physicians in leadership positions was identified via survey: Director of IC and EP, and Chief of Cardiology. Firth's logistic model controlling for covariates modeled the rare event of a woman implanter.

RESULTS

Data obtained on 100% of cohort. Men comprised 97% of implanters (860/886). No difference in subspecialty or implants by gender. There were 414 hospitals performing WATCHMAN: 24% academic, 97% urban, and most medium/large sized (94%). EP made up 61% of implanters. Only 4.8% of hospitals had women in selected leadership roles. Women represented <1% of Directors of IC and only 2.6% of both Directors of EP and Chiefs of Cardiology. Hospitals with a woman in leadership had four times greater odds of a woman implanter (OR=4.24, 95% CI 1.16-15.41, p=0.028).

CONCLUSIONS AND RELEVANCE

Women are underrepresented in cardiology procedural subspecialties in use of novel technology and key leadership roles. There was a greater odds of women early implanters of WATCHMAN if a woman led locally. Increasing women in leadership may improve gender diversity though visibility of role models.