Guiding Principles and Member Guidance: Maternal CV Care

*The following guiding principles and member guidance regarding maternal cardiovascular care are intended help members as they continue to provide the highest levels of care to patients following the recent Supreme Court decision on Dobbs vs. Jackson. They can also be accessed on ACC.org.

Background:

The ACC has long advocated for patients engaging with their doctor and the cardiovascular care team about their heart health and related risks. Shared decision-making is an essential tool in helping to navigate the risks and benefits of all treatment options, taking into account the latest science and medical evidence, social determinants of health, emphasis on health equity, and the patient’s own beliefs and goals.

While the ACC has no official policy on abortion, clinical practice guidelines and other clinical guidance tools address the dangers of pregnancy in certain patient populations at higher risk of death or serious cardiac events. As such, the College is deeply concerned about the potential implications of the Supreme Court decision regarding Dobbs vs. Jackson on the ability of patients and clinicians to engage in important shared discussions about maternal health, or to remove previously available health care options, especially given the alarming maternal health crisis in the U.S.

Similar to topics like gun violence that impact the broader medical community and the patients we serve, the ACC will continue to work with the larger House of Medicine to address specific laws and policies as they move forward that would threaten or criminalize patient-clinician discussions regarding maternal cardiovascular care.

Guiding Principles:

ACC’s mission is to transform cardiovascular care and improve heart health. We are patient-centered in our decisions and value teamwork, collaboration, professionalism and excellence.

  1. Cardiovascular disease is the leading cause of maternal mortality, a substantial and growing problem in the US. A recent study noted a 33% increase in US maternal mortality during the pandemic.
  2. Cardiovascular professionals are experts in the care of the women with cardiovascular disease who are or may become pregnant.
  3. The field of cardio-obstetrics is one of the fastest growing fields in CV medicine, and has developed a growing body of medical science, scientific literature, and practice standards (e.g. JACC five-part Cardio-Obstetrics Focus Seminar).
  4. Cardiovascular professionals bear professional responsibility to women with a variety of cardiovascular diseases which may create substantial risk of morbidity and mortality during pregnancy.
  5. Our standards of practice include counseling and shared decision-making with our patients regarding use of contraception and pregnancy termination. Important components of these decisions include knowledge of maternal risks associated with certain cardiovascular conditions and patients’ values, goals and willingness to take risk. These are among the hardest conversations that we undertake as cardiovascular professionals.
  6. We have a common interest in ensuring that cardiovascular professionals can continue to provide optimal cardiovascular care to produce the best possible outcomes for our pregnant patients with cardiovascular disease.
  7. The law must allow space for cardiovascular professionals to provide counseling to pregnant patients with cardiovascular disease that includes all medically-appropriate options, as established by medical science and practice standards.

Member Guidance:

  1. Cardiovascular professionals caring for pregnant women with heart disease should work in multi-disciplinary teams, with the patient at the center of each team. These teams are more common in large hospital systems or multispecialty clinics.
  2. Health care professionals managing the care of pregnant women with cardiovascular disease who are not supported by a large enterprise should consider referring these patients to larger systems with more layers of support and experience.
  3. In states currently or imminently restricting abortion, clinicians caring for pregnant women with heart disease should seek the counsel of risk management experts within their system and their hospital staff leadership. They should also work with their state medical societies and state representatives for the American College of Obstetrics and Gynecology (ACOG) to understand the relevant laws in their state.
  4. Cardiovascular professionals providing telehealth consultations for pregnant women with cardiovascular disease across state lines should obtain legal support from counsel in the state where the patient resides as well as their home state/institution.
  5. Cardiovascular professionals who provide care to women of childbearing age should understand the tools used to predict risk conferred by various types of cardiovascular disease and pregnancy and understand which forms of contraception are safe to use. Clinicians without relevant expertise or experience should identify the cardio-obstetric and women’s heart health programs best suited to provide care to their patients.
  6. Individual hospitals and health systems should communicate with their state medical societies and ACOG chapters concerning this issue. Angela Shuman, ACC Director of State Government Affairs, and her team can facilitate contact with the state medical society’s staff as needed.
  7. The ACC’s Cardio-Obstetrics Work Group will be developing a set of educational tools that can be used for the following purposes:
    • Formal educational presentations to colleagues
    • Educational materials for PCP and ObGyns and other medical team members
    • Educational materials which can be used to educate elected state officials (via email, social media and in-person visits)
    • Patient education materials about heart disease and pregnancy risk, cardiovascular health promotion, and wellness

NEW FIT Lecture Series: Pericarditis on Aug. 9

Join us the second Tuesday of each month for our ongoing Fellows in Training (FIT) Lecture Series. On Tuesday, August 9th from 6-8pm Kathryn F. Larson, M.D., Chief Fellow in the Division of Cardiology at Mayo Clinic will present a talk on Pericarditis.

This event is free, but registration is required. Register here and mark your calendars for the second Tuesday of every month to join us for future lectures.

Kathryn F. Larson, M.D.

Presentation

Using a case-based format, we will review the basics of diagnosis, ancillary testing, and therapeutics for pericarditis. The talk will include a discussion of the 2015 ESC Guidelines on pericardial disease, as well as a brief overview of key pivotal trials in the management of pericarditis (both initial episodes and recurrence).

Professional Development Series – Meet the Inventor: How TAVI Was Born

Saturday, May 14th, 2022

10 a.m. Central | Zoom

While listening to Julio Palmaz speak at a conference in Scottsdale, Arizona in February 1989, Henning Rud Andersen was inspired to concept implanting heart valves percutaneously. Within 3 months, Dr. Andersen made and implanted the first transcatheter heart valve in an animal model. Today, TAVI is the main treatment of severe aortic stenosis in many parts of the world. Join Drs. Mohamad Alkhouli and David R. Holmes for a virtual conversation with Dr. Andersen about his extraordinary journey with TAVI.

Moderators: Mohamad Alkhouli MD, FACC and David Holmes MD

Guest: Henning Rud Andersen MD

View the event flyer here.

2022 FIT Echo Bootcamp Registration Now Open

Presented by the Iowa and Minnesota Chapters of the American College of Cardiology

Registration is now open for our third annual FIT Echo Bootcamp. Join other Fellows in Training for an in-depth study on Echocardiographic Examinations and Emergencies led by Dr. Rick Marcus of the Iowa Heart Center. This four-part virtual series will take place from 6-8 pm Central on July 5th, 7th, 12th and 14th. Visit the FIT Echo Bootcamp page for more information.

Lifetime Management of Aortic Stenosis: Educational Opportunity in MN

In a growing number of sites across the country, structural heart programs are drawing on the experience of Advance Practice Providers to manage the continuum of care the Structural Heart patients. The MN APP Program has been designed to advance the care of patients with structural heart disease, with an emphasis on current challenging clinical topics coupled with the latest scientific evidence to guide patient treatment and long-term management of patients suffering from Aortic Stenosis. This program, presented by Edwards Lifesciences, is intended for Advanced Practice Providers (NPs, APNs, PA-Cs) in the greater MN area.

Topics for this program will include:

  • Timely Diagnosis and Treatment can lead to better outcome
  • Essential Role of various imaging modalities before, during and after TAVR
  • Evolution of APP leadership in Structural Heart Program
  • Strategies to streamline organizational process to build sustainable structural heart program (Pre, Peri, Post)
  • Importance of Multi-discipline Heart Team: Effective staffing models for clinic, procedure, and post-care

Date

Thursday, May 12, 2022
General Session: 1:00 PM – 7:00 PM CST

Location

Hotel Ivy – Grand Salon room
201 S 11th St.
Minneapolis, MN 55403

Midwest ACC WIC Symposium – Register Now

Registration is now open for the 5th Annual Midwest ACC Women in Cardiology (WIC) Symposium to be held on June 25, 2022 at the Women’s Athletic Club in Chicago, Illinois.

This symposium aims to share knowledge and best practices with all clinicians who care for female patients to improve the overall cardiovascular health of women. Attendees will have the opportunity to attend in person or virtually live the day of the symposium.

Female FITs are encouraged to submit abstracts and male FITs are encouraged to submit abstracts investigating women and cardiovascular disease or topics that help women cardiologists succeed in their careers. Cash prizes will be awarded for the 1st, 2nd, and 3rd best abstracts.

This year’s keynote speaker is the Immediate Past ACC President, Dr. Dipti Itchhaporia, whose presentation will be followed by an interview by several female governors of the Midwest Chapters about her journey to her presidency. The morning program will address various common cardiovascular diseases, focusing on sex differences. The afternoon program is packed with panel discussions and breakout sessions to help cardiovascular clinicians and scientists navigate their careers.

Don’t miss this networking and educational opportunity!


ACC-MN Leaders Meet with Minnesota Legislators & Staff

We appreciate time spent with staff of legislators to confirm support on critical services that impact quality heart & patient care! Thank you to the offices of Representative Tom Emmer, Congressman Jim Hagedorn, Senator Amy Klobuchar, Representative Betty McCollum, Congresswoman Ilhan Omar, Representative Dean Phillips, Senator Tina Smith, Representative Pete Stauber. Representing the Minnesota Chapter of the American College of Cardiology were Board President Stephen J. Smalley, M.D., FACC; Board President-Elect Retu Saxena, M.D., FACC; Board Secretary-Treasurer Sharath S. Subramanian, MBBS, M.D., FACC; Board Member Catherine (Katie) Benziger, M.D., MPH, FACC; Michael W. Cullen, M.D.; and Marysia S. Tweet, M.D., M.S.

1 2