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Dilmaghani D, Nath KA, Garovic VD. Increasing Maternal Mortality in the United States: Looking Beneath and Beyond the Numbers. Mayo Clin Proc 2024; 99:873-877. [PMID: 38839188 DOI: 10.1016/j.mayocp.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Darah Dilmaghani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Karl A Nath
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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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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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: 0] [Impact Index Per Article: 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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Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration. J Cardiovasc Dev Dis 2022; 9:jcdd9070199. [PMID: 35877562 PMCID: PMC9320047 DOI: 10.3390/jcdd9070199] [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: 05/26/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/04/2023] Open
Abstract
The prevalence of CVD in pregnant people is estimated to be around 1 to 4%, and it is imperative that clinicians that care for obstetric patients can promptly and accurately diagnose and manage common cardiovascular conditions as well as understand when to promptly refer to a high-risk obstetrics team for a multidisciplinary approach for managing more complex patients. In pregnant patients with CVD, arrhythmias and heart failure (HF) are the most common complications that arise. The difficulty in the management of these patients arises from variable degrees of severity of both arrhythmia and heart failure presentation. For example, arrhythmia-based complications in pregnancy can range from isolated premature ventricular contractions to life-threatening arrhythmias such as sustained ventricular tachycardia. HF also has variable manifestations in pregnant patients ranging from mild left ventricular impairment to patients with advanced heart failure with acute decompensated HF. In high-risk patients, a collaboration between the general obstetrics, maternal-fetal medicine, and cardiovascular teams (which may include cardio-obstetrics, electrophysiology, adult congenital, or advanced HF)—physicians, nurses and allied professionals—can provide the multidisciplinary approach necessary to properly risk-stratify these women and provide appropriate management to improve outcomes.
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Screening for Cardiovascular Disease in Pregnancy: Is There a Need? J Cardiovasc Dev Dis 2022; 9:jcdd9030089. [PMID: 35323636 PMCID: PMC8953180 DOI: 10.3390/jcdd9030089] [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: 02/20/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Maternal mortality in the United States has been on the rise. Every year, about 700 women die from pregnancy-related complications. Cardiovascular disease (CVD) accounts for a large majority of pregnancy-related deaths driven by the lack of recognition and delays in diagnosis due to the overlap of normal pregnancy symptoms with those of CVD. Risk factors for CVD including race, advanced maternal age, hypertension, diabetes, obesity, socioeconomic status, and geographic region play an important role in CVD-related deaths. Several risk assessment models are available to stratify women with a known diagnosis of CVD. However, most women who die from CVD during pregnancy or the postpartum period do not have a prior diagnosis of CVD, and cardiomyopathy is an important contributor. The California Maternal Quality Care Collaborative (CMQCC) developed an algorithm to screen all pregnant and postpartum women to allow stratification into low or high risk for CVD. The algorithm has been validated in diverse patient populations. We propose universal CVD screening for all women in the antepartum and postpartum period to identify women at risk and to provide education and awareness for both patients and healthcare providers. This screening tool would work to reduce the increasing rates of severe maternal mortality and morbidity while having a significant impact on healthcare costs in the United States.
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Maxner B, Hansra B, Sibai D, Moinul S, Panella L, Jeha J, Fiore C, Dumont T, Lauring J, Aurigemma G, Harrington CM, Kovell LC. Developing a curriculum to improve cardiology fellows' training in pregnancy and cardiovascular disease. BMC MEDICAL EDUCATION 2022; 22:166. [PMID: 35272659 PMCID: PMC8912945 DOI: 10.1186/s12909-022-03228-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exposure to pregnant women with cardiovascular disease (CVD) during cardiology fellowship training is limited and without a standard curriculum in the United States. The authors sought to evaluate a dedicated curriculum to teach management of CVD in pregnancy to improve general cardiology fellowship training. METHODS The authors developed a dedicated CVD in pregnancy curriculum for the general cardiology fellows at a large academic medical center in the fall of 2019. Fellows' knowledge was assessed via a board-style examination and exposure and attitudes related to the care of pregnant women with CVD were evaluated with a needs assessment questionnaire before and after the curriculum. RESULTS Of the 17 fellows who participated in the curriculum, 12 completed the needs assessment pre-curriculum and 9 post-curriculum. The mean (SD) number of pregnant women with CVD cared for by each fellow in the inpatient and outpatient settings were 0.75 (1.29) and 0.56 (0.73), respectively. After the curriculum, all fellows reported awareness of available resources to treat pregnant women with CVD, while a majority disagreed that they receive regular exposure to pregnant patients with CVD in their training. The authors observed significant increases in fellows' confidence in their knowledge of normal cardiovascular physiology of pregnancy, physical exam skills, and ability to care for pregnant women with valvular disease and arrhythmias from pre to post-curriculum. A total of 15 fellows completed the board-style exam pre-curriculum and 15 post-curriculum. Fellows' performance on the board-style examination improved slightly from before to after the curriculum (64.0 to 75.3% correct, p = 0.02). CONCLUSIONS A dedicated curriculum improved cardiology fellows' knowledge to recognize and treat CVD in pregnancy and improved confidence in caring for this unique patient population.
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Affiliation(s)
- Benjamin Maxner
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Barinder Hansra
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
| | - Diana Sibai
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Sheikh Moinul
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Leslie Panella
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeannine Jeha
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catherine Fiore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tina Dumont
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Julianne Lauring
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Gerard Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Colleen M Harrington
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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