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

Abstract

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.

Early identification and treatment of women's cardiovascular risk factors prevents cardiovascular disease, saves lives, and protects future generations: Policy recommendations and take action plan utilizing policy levers

“…A recent survey of US cardiologists, CV team members, and trainees showed that although CVD is the number‐one cause of pregnancy‐related deaths in the United States, there are significant gaps in knowledge and confidence among providers pertaining to care of pregnant and postpartum women with CVD. This finding supports the need for developing new standards for training and educating members of the cardiology and obstetrics workforce to optimize the care provided to young mothers, and to facilitate the expansion of dedicated cardio‐obstetrics centers 20 . These efforts will improve the care we provide to women at risk for CVD who are planning or experiencing pregnancy and may help reverse the alarming increase in rates of maternal morbidity and mortality experienced in the United States.…”

“…This finding supports the need for developing new standards for training and educating members of the cardiology and obstetrics workforce to optimize the care provided to young mothers, and to facilitate the expansion of dedicated cardio‐obstetrics centers. 20 These efforts will improve the care we provide to women at risk for CVD who are planning or experiencing pregnancy and may help reverse the alarming increase in rates of maternal morbidity and mortality experienced in the United States.…”

Reproductive Experiences and Cardiovascular Disease Care in Pregnancy Capable and Post-Menopausal Individuals: Insights from the American Heart Association Research Goes Red Registry

“…8 A recent national survey of cardiologists, cardiovascular team members and cardiology fellows in training, identified that over 75% of respondents lacked access to a dedicated cardio-obstetrics team, and only 29% of cardiologists received didactics on cardio-obstetrics during training, suggesting that augmentation of cardioobstetrics education is needed to reduce the large knowledge gaps that exist among clinicians. 18 These data also identify a need for more education, both for physicians and for patients, on recognizing the association between APOs and long-term CVD risk in mothers. 6 When analyzing data from a multiracial cohort of postpartum individuals, the prevalence of self-reported screening and diagnosis of PPD was 82% and 13%, respectively.…”

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine

“…10 Subspecialists across the internal medicine disciplines of rheumatology, pulmonary and critical care medicine, gastroenterology/transplant hepatology, cardiology, nephrology, endocrinology, infectious disease, and hematology-oncology, indicate that they do not have the basic knowledge, skills, or resources to manage disease-related aspects of sexual and reproductive health (SRH). [13][14][15][16][17][18][19][20][21][22] Our collective of multidisciplinary subspecialty clinicians and health services researchers has described some of the common challenges that subspecialists feel undermine their provision of SRH…”

“…across the internal medicine disciplines of rheumatology, pulmonary and critical care medicine, gastroenterology/transplant hepatology, cardiology, nephrology, endocrinology, infectious disease, and hematology-oncology, indicate that they do not have the basic knowledge, skills, or resources to manage disease-related aspects of sexual and reproductive health (SRH). [13][14][15][16][17][18][19][20][21][22] Our collective of multidisciplinary subspecialty clinicians and health services researchers has described some of the common challenges that subspecialists feel undermine their provision of SRH care. 4,14,23,24 Our qualitative research also indicates that many patients with chronic diseases feel that their SRH needs are not met in the current subspecialty care model [25][26][27][28] ; they overwhelmingly desire for their subspecialists to address their SRH as it relates to their diseases, but with a holistic approach that accounts for the greater context of their values, preferences, and life circumstances.…”