Cardiovascular Fellowship Training in Cardio-Obstetrics
Why the study?
The United States has the highest maternal mortality in the developed world with cardiovascular disease as the leading cause of pregnancy-related deaths, highlighting the need for cardiologists trained in cardio-obstetrics.
Key Points
- To establish a standardized educational framework for integrating cardio-obstetrics into cardiovascular disease fellowship training programs to enhance clinical expertise and lower maternal mortality.
- An expert writing committee with leadership from the American College of Cardiology Reproductive Health and Cardio-Obstetrics Section, fellowship directors, and trainees evaluated educational needs.
- The committee reviewed existing literature, ACGME requirements, and national survey data regarding cardiology fellows and clinicians caring for pregnant patients.
- Prior survey data revealed that 66% of cardiologists received no formal cardio-obstetrics didactics during training, and only 12% of fellows-in-training reported receiving formal instruction.
- Clinicians reported substantial knowledge gaps in managing pregnancy-related acute coronary syndrome (39%), aortopathies (40%), valvular heart disease (30%), and medication safety (42%).
- The document establishes core competencies across hemodynamic changes, preconception counseling, risk stratification, and tiered training tracks to address maternal mortality that reached 32.9 deaths per 100,000 live births in 2021.
Structured PICO
P
Population
Review providing a blueprint for incorporating cardio-obstetrics training into cardiovascular disease fellowship programs.
I
Intervention
Cardio-obstetrics training framework (Levels I, II, and III)
Establishing structured cardio-obstetrics training in cardiovascular fellowships is a critical step toward equipping cardiologists to manage the leading cause of maternal mortality.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These results paint a clear picture of the lack of resources, education and training that cardiologists, fellows, and their care teams receive in the field of cardio-obstetrics. With rates of pregnancy-related cardiovascular disease on the rise, now is the time to expedite better, and broader, training in the field.”
“I was somewhat surprised by the low numbers. I didn't think we would see exceptionally high rates of training reported by people who have been in practice, but it was especially eye opening to find that 83% of current fellows report no formal training available in their program.”
“In this country, the risk of morbidity and mortality related to pregnancy is appalling. We can and must do better. By working together and forming dedicated teams and communities, we can improve the health of women with cardiovascular disease and those at risk, thereby benefiting mothers and their families for the decades that follow.”
Implication
Fellowship programs should adopt the proposed multi-tiered cardio-obstetrics curriculum; extends prior consensus statements to address maternal cardiovascular mortality.
Abstract
The United States has the highest maternal mortality in the developed world with cardiovascular disease as the leading cause of pregnancy-related deaths. In response to this, the emerging subspecialty of cardio-obstetrics has been growing over the past decade. Cardiologists with training and expertise in caring for patients with cardiovascular disease in pregnancy are essential to provide effective, comprehensive, multidisciplinary, and high-quality care for this vulnerable population. This document provides a blueprint on incorporation of cardio-obstetrics training into cardiovascular disease fellowship programs to improve knowledge, skill, and expertise among cardiologists caring for these patients, with the goal of improving maternal and fetal outcomes. (J Am Coll Cardiol 2023;82:1792-1803)
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Cite This Study
Davis et al. (2023) conducted a review in Cardiovascular disease in pregnancy. Cardio-obstetrics training framework was evaluated. This document provides a blueprint for incorporating multi-tiered cardio-obstetrics training into cardiovascular disease fellowship programs to improve maternal and fetal outcomes.