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      Improving Cardiovascular Workforce Competencies in Cardio‐Obstetrics: Current Challenges and Future Directions

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          Abstract

          Maternal mortality in the United States is the highest among all developed nations, partly because of the increased prevalence of cardiovascular disease in pregnancy and beyond. There is growing recognition that specialists involved in caring for obstetric patients with cardiovascular disease need training in the new discipline of cardio‐obstetrics. Training can include integrated formal cardio‐obstetrics curricula in general cardiovascular disease training programs, and developing and disseminating joint cardiac and obstetric societal guidelines. Other efforts to help strengthen the cardio‐obstetric field include increased collaborations and advocacy efforts between stakeholder organizations, development of US‐based registries, and widespread establishment of multidisciplinary pregnancy heart teams. In this review, we present the current challenges in creating a cardio‐obstetrics community, present the growing need for education and training of cardiovascular disease practitioners skilled in the care of obstetric patients, and identify potential solutions and future efforts to improve cardiovascular care of this high‐risk patient population.

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          Most cited references26

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          ACOG Committee Opinion No. 736

          (2018)
          The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their obstetrician-gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician-gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit. Obstetrician-gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new paradigm for postpartum care.
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            2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary

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              Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists

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                Author and article information

                Contributors
                gsharma8@jhmi.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                02 June 2020
                16 June 2020
                : 9
                : 12 ( doiID: 10.1002/jah3.v9.12 )
                : e015569
                Affiliations
                [ 1 ] Division of Cardiology Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases Johns Hopkins University School of Medicine Baltimore MD
                [ 2 ] Division of Cardiology Corrigan Minehan Heart Center Massachusetts General Hospital Harvard Medical School Boston MA
                [ 3 ] Division of Cardiology Department of Medicine Emory School of Medicine Atlanta GA
                [ 4 ] Department of Obstetrics and Gynecology Saint Luke's Hospital Kansas City MO
                [ 5 ] Division of Maternal‐Fetal Medicine Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore MD
                [ 6 ] Division of Cardiology Department of Medicine The Ohio State University Wexner Medical Center Columbus OH
                Author notes
                [*] [* ]Correspondence to: Garima Sharma, MD, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 7125 A, Baltimore, MD 21287. E‐mail: gsharma8@ 123456jhmi.edu
                Author information
                https://orcid.org/0000-0001-7254-2077
                Article
                JAH35175
                10.1161/JAHA.119.015569
                7429047
                32482113
                9e6f9d3a-49b7-4759-a4ca-0f5eb6bd06ab
                © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Page count
                Figures: 2, Tables: 3, Pages: 8, Words: 5193
                Categories
                Mini‐Review
                Mini‐Review
                Custom metadata
                2.0
                16 June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.5 mode:remove_FC converted:19.07.2020

                Cardiovascular Medicine
                cardio‐obstetrics,cardiovascular disease prevention,preeclampsia/pregnancy,pregnancy and postpartum,training,cardiovascular disease,quality and outcomes,statements and guidelines,ethics and policy

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