Dr Kathryn Lindley Explains the Importance of Cardio-Obstetrics in Fellowship Programs

Kathryn Lindley, MD, FACC –

Vanderbilt University Medical Center

Cardiovascular disease is the leading cause of maternal mortality in the United States, which has the highest infant and maternal mortality rates out of any other high-income country while also spending the most on health care.

In an interview with The American Journal of Managed Care® (AJMC®), Kathryn Lindley, MD, FACC, associate professor of medicine and associate professor of obstetrics and gynecology at Vanderbilt University Medical Center, explains the importance of cardio-obstetrics, why training needs to be incorporated into cardiovascular disease fellowship programs, and why cardiologists should know the basics about pregnancy care.

AJMC: What is cardio-obstetrics, and why is it important in the field of cardiology?

Lindley: Cardio-obstetrics, broadly, is really thinking about the care of reproductive age women when thinking about taking care of their cardiovascular health. This means thinking about taking care of women with cardiovascular disease or cardiovascular risk factors before pregnancy, helping counsel them on their risk of pregnancy complications and contraception counseling and helping optimize their cardiovascular risk before pregnancy, obviously managing them through pregnancy, and then also managing them in that postpartum time when women are at high risk for having pregnancy-related complications, and helping improve their cardiovascular health in between pregnancies. Another really important aspect of cardio-obstetrics is also thinking about how pregnancy and pregnancy complications impact long-term risk. We know that some cardiac complications of pregnancy, such as high blood pressure during pregnancy, or gestational diabetes, can ultimately lead to a higher risk of long-term cardiovascular complications, such as strokes or heart failure, even decades later. It's taking that information and thinking about how we could modify a patient's risk, and using that information to keep them healthy over the long term.

AJMC: How can incorporating cardio-obstetrics training into cardiovascular disease fellowship programs improve maternal and fetal outcomes?

Lindley: Unfortunately, pregnancy care is not something that cardiologists or even internal medicine specialists have really been traditionally trained in, so we typically as a specialty have very little experience in counseling these patients or managing complications in them. What we do know, however, is that cardiovascular disease is now the leading cause of maternal mortality in the United States, so it's becoming increasingly important that cardiologists understand how to take care of pregnant patients and postpartum patients, and how to really effectively risk stratify them and provide effective treatments. In order for us to do that, we really have to rethink about how we educate cardiovascular trainees so that all cardiologists come out with a standard basic level of training, such that all cardiologists are able to effectively risk stratify patients and recognize cardiovascular complications in pregnancy in high-risk conditions. Then someone who doesn't specialize in cardio-obstetrics can then recognize those conditions, and refer those patients onto someone who does specialize in that disease.

AJMC: What are some challenges in implementing cardio-obstetrics training into cardiovascular disease fellowship programs, and how can these challenges be addressed?

Lindley: The biggest challenge right now is that there's really no requirement for cardio-obstetrics training, so we really can't implement training on a broad level if there are no requirements for it. Of course, there are a lot of different things that cardiologists need to be trained on in order to come out as a competent cardiologist, and we do think this is one of those things that all competent cardiologists should have a baseline level of knowledge in. In order to ensure that all cardiologists will receive some basic training in cardio-obstetrics, it really needs to be implemented as a requirement in our cardiovascular training guidelines document, which is called the COCATS [Core Cardiology Training Symposium] criteria. Those of us who are leading this area in the field are really looking to see this recommendation be incorporated into the next version of COCATS to sort of recognize that, even if you're a heart rhythm specialist or interventional specialists, you still need to know the basics about pregnancy care for cardiologists.

Reference

1. Petrullo J. US has highest infant, maternal mortality rates despite the most health care spending. AJMC. January 31, 2023. Accessed December 4, 2023. https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending