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.
Introduction: Heart healthy diets are important in the prevention and treatment of hypertension (HTN). In pregnant women, the lifestyle barriers to healthy eating are not well-described in literature. Hypothesis: There are personal, environmental, and economic barriers impacting adherence to a healthy diet in pregnant women with HTN, hypertensive disorders of pregnancy (HDP), or risk factors for HDP. Methods: Pregnant women, aged 20-50 (N=28), diagnosed with HTN, HDP, or risk factors for HDP were recruited from a large academic medical center. Participants completed an electronic survey assessing personal, environmental, and economic barriers to healthy eating. A 5-point Likert scale was used, ranging from strongly agree to strongly disagree. Results: The average age of participants was 31.8 (SD=4.5) from urban (34.6%), suburban (34.6%), and rural (30.8%) communities. Finances and time were major barriers to healthy eating, reported by 39.3% and 28.6% of participants, respectively, with 17.8% reporting that they could not afford to eat healthy consistently for all meals (Figure 1). Additionally, 10.7% and 7.1% were unaware of factors promoting healthy eating such as awareness of outside healthy eating resources and confidence in their ability to eat healthy given a new pregnancy. Meanwhile, 28.6% and 17.9% reported ambivalence towards these factors. Conclusion: Time management and financial costs emerged as the greatest challenges to healthy eating in pregnant women with or at risk for HDP. These barriers, in addition to certain factors promoting healthy eating, may represent areas of intervention that can help mitigate the obstacles to healthy eating in this vulnerable group.
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