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Artikel ; Online: "Cardio-Obstetrics": A Burgeoning Field in Need of Increased Awareness, Training, and Collaboration.

Windram, Jonathan / Siu, Samuel C

2021 Band 37, Heft 12, Seite(n) 2076–2079

Abstract: Cardiovascular disease is now the leading cause of maternal mortality in the industrialised nations. This public health crisis is driven by a variety of factors, including advancing maternal age, increasing prevalence of diabetes and hypertension and the ...

Abstract	Cardiovascular disease is now the leading cause of maternal mortality in the industrialised nations. This public health crisis is driven by a variety of factors, including advancing maternal age, increasing prevalence of diabetes and hypertension and the growing number of adults with congenital heart disease. To meet the needs of this complex and diverse population, the subspecialty of cardio-obstetrics has developed. By its very nature, cardio-obstetrics is a team endeavour and requires contributions from multiple disciplines to deliver optimal care. In this article, we argue that cardio-obstetrics is not a niche issue. The magnitude of the current health challenges makes it imperative that all physicians who care for women of childbearing age have a basic knowledge of how cardiovascular disease can impart risk to women during and beyond pregnancy. We address how to increase awareness within the general medical community so that health care workers are able to recognise potential issues and are aware of how to refer to appropriate specialists. We discuss how to incorporate this within cardiology training so that general cardiologists consider the implications that pregnancy has on their patients. And we reflect on the training of the obstetric cardiologists of tomorrow as this field continues to evolve.
Mesh-Begriff(e)	Awareness ; Cardiology/education ; Education, Medical, Graduate/methods ; Female ; Humans ; Obstetrics/education ; Pregnancy ; Pregnancy Complications, Cardiovascular/epidemiology ; Public Health ; Specialization
Sprache	Englisch
Erscheinungsdatum	2021-09-24
Erscheinungsland	England
Dokumenttyp	Journal Article ; Review
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2021.09.019
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Comparing the outcomes of rheumatic heart disease in pregnancy complicated with and without atrial fibrillation: A propensity score matched analysis.

Keepanasseril, Anish / Pande, Swaraj Nandini / Suriya, Yavana / Baghel, Jyoti / Mondal, Nivedita / Pillai, Ajith A / Satheesh, Santhosh / Siu, Samuel C

American heart journal

2024

Abstract: Background: Atrial fibrillation (AF) may increase the risk of adverse maternal and fetal outcomes among pregnant with rheumatic valvular lesions (RHD). We aimed to assess the rate of occurrence of AF in pregnant with RHD and its impact on cardiac and ... ...

Abstract	Background: Atrial fibrillation (AF) may increase the risk of adverse maternal and fetal outcomes among pregnant with rheumatic valvular lesions (RHD). We aimed to assess the rate of occurrence of AF in pregnant with RHD and its impact on cardiac and maternal-fetal outcomes compared to those without it. Methods: The study group consisted of pregnant women with RHD and AF (cases) and a matched comparison group of pregnant women with RHD but without AF (controls) was derived from the database of pregnant women with RHD receiving care at our center between 2011 and 2021. Incidence of composite adverse outcomes(maternal death, heart failure, or thrombo-embolic events) and pregnancy outcomes were compared between them. Results: Seventy-one (5.1%; 95%CI 4.1%-6.4%) pregnant women with RHD had AF during pregnancy and childbirth, most occurring in the late second or early third trimester. New-onset AF was diagnosed in 34 (47.9%) of them. After matching, the incidence of composite outcome was higher in women with AF (77.5% (95%CI 66.3%-85.7%) compared to women without AF (17.3%(95%CI 13.3%-22.1%), P < .001), with seven (9.9%) maternal deaths among cases and two (0.7%) in controls. Heart failure was the most common adverse cardiac event (26.7% vs. 4.2%, P < .001, cases vs controls). Those with AF had higher odds (adjusted OR 56.6 (14.1-226.8)) of adverse cardiac outcomes after adjusting for other risk factors. The frequency of most non-cardiac pregnancy complications was similar in both groups. However, there was a trend towards a higher rate of miscarriage (16.9% vs. 9.9%), small-for-gestational-age babies(16.3 vs. 9.0%), and cesarean rates(31.9% vs. 18.3%) women with AF compared to those who did not experience AF. Conclusions: Atrial fibrillation in pregnancy among women with RHD was associated with an increased risk of maternal morbidity and mortality, with a trend towards an increase in some non-cardiac pregnancy complications compared to those pregnant women without AF. Our study results provide background data for developing and implementing a pregnancy-specific management strategy tailored to middle-income settings.
Sprache	Englisch
Erscheinungsdatum	2024-04-16
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2024.04.002
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Designing a Multidisciplinary Cardio-obstetrics Curriculum for General Cardiology and Obstetrics Residents: A National Survey of Educational Needs.

Blissett, Sarah / Alphonsus, Lotus / Eastabrook, Genevieve / Banner, Harrison / Siu, Samuel C

CJC open

2023 Band 6, Heft 2Part B, Seite(n) 174–181

Abstract: Background: The increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and ... ...

Abstract	Background: The increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and obstetrics and gynecology (OBGYN) residents, we need to define educational needs from the perspectives of both cardiology and OBGYN residents. Our study characterizes the educational needs of Canadian cardiology and OBGYN residents. Methods: Canadian cardiology and OBGYN residents were surveyed on clinical exposures, perceived needs for topics, unperceived needs for topics (multiple-choice questions) and preferences for educational formats. High priorities were defined as ≥ 50% of responses indicating a perceived need or ≥ 50% indicating an unperceived need. Results: A total of 154 residents participated (cardiology n = 44, OBGYN n = 110). Residents reported insufficient clinical exposure to nearly all cardiac disorders, with 33% of exposures occurring in multidisciplinary contexts. All topics aside from gestational hypertension were rated as high priority on perceived needs by both specialties. High-priority unperceived needs were congenital heart disease (both specialties), pre-existing acquired heart disease (both specialties), medication safety (OBGYN), peripartum management (OBGYN), and pregnancy-related heart disease (OBGYN). Cardiology and OBGYN residents shared preferences for in-person simulation, virtual simulation, and online modules. Conclusions: Residents in both specialties reported low clinical exposure to most cardiac disorders during pregnancy, identified high-priority perceived needs in multiple topics, and shared 2 high-priority unperceived needs. OBGYN residents identified 3 additional high-priority unperceived needs. These data can inform design of multidisciplinary cardio-obstetrics curricula for general cardiology and OBGYN residents.
Sprache	Englisch
Erscheinungsdatum	2023-12-18
Erscheinungsland	United States
Dokumenttyp	Journal Article
ISSN	2589-790X
ISSN (online)	2589-790X
DOI	10.1016/j.cjco.2023.12.014
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: New Hypertension After Pregnancy in Patients With Heart Disease.

Siu, Samuel C / Lee, Douglas S / Fang, Jiming / Austin, Peter C / Silversides, Candice K

Journal of the American Heart Association

2023 Band 12, Heft 10, Seite(n) e029260

Abstract: Background After pregnancy, patients with preexisting heart disease are at high risk for cardiovascular complications. The primary objective was to compare the incidence of new hypertension after pregnancy in patients with and without heart disease. ... ...

Abstract	Background After pregnancy, patients with preexisting heart disease are at high risk for cardiovascular complications. The primary objective was to compare the incidence of new hypertension after pregnancy in patients with and without heart disease. Methods and Results This was a retrospective matched-cohort study comparing the incidence of new hypertension after pregnancy in 832 patients who are pregnant with congenital or acquired heart disease to a comparison group of 1664 patients who are pregnant without heart disease; matching was by demographics and baseline risk for hypertension at the time of the index pregnancy. We also examined whether new hypertension was associated with subsequent death or cardiovascular events. The 20-year cumulative incidence of hypertension was 24% in patients with heart disease, compared with 14% in patients without heart disease (hazard ratio [HR], 1.81 [95% CI, 1.44-2.27]). The median follow-up time at hypertension diagnosis in the heart disease group was 8.1 years (interquartile range, 4.2-11.9 years). The elevated rate of new hypertension was observed not only in patients with ischemic heart disease, but also in those with left-sided valve disease, cardiomyopathy, and congenital heart disease. Pregnancy risk prediction methods can further stratify risk of new hypertension. New hypertension was associated with an increased rate of subsequent death or cardiovascular events (HR, 1.54 [95% CI, 1.05-2.25]). Conclusions Patients with heart disease are at higher risk for developing hypertension in the decades after pregnancy when compared with those without heart disease. New hypertension in this young cohort is associated with adverse cardiovascular events highlighting the importance of systematic and lifelong surveillance.
Mesh-Begriff(e)	Pregnancy ; Female ; Humans ; Cohort Studies ; Retrospective Studies ; Hypertension/epidemiology ; Myocardial Ischemia ; Heart Defects, Congenital ; Risk Factors
Sprache	Englisch
Erscheinungsdatum	2023-05-09
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.029260
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The role of multidisciplinary simulations in cardio-obstetrics education: perspectives from simulated hemodynamically unstable patients.

Skinner, Jamila Y / Banner, Harrison / Cristancho, Sayra / Siu, Samuel / Blissett, Sarah

American journal of obstetrics & gynecology MFM

2023 Band 5, Heft 9, Seite(n) 101052

Mesh-Begriff(e)	Female ; Humans ; Pregnancy ; Obstetrics/education ; Patient Simulation
Sprache	Englisch
Erscheinungsdatum	2023-06-14
Erscheinungsland	United States
Dokumenttyp	Letter
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2023.101052
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Reply: Risk Estimation in Valvular Heart Disease in Pregnancy.

Keepanasseril, Anish / Pande, Swaraj Nandini / Satheesh, Santhosh / Siu, Samuel C / D'Souza, Rohan

Journal of the American College of Cardiology

2023 Band 83, Heft 5, Seite(n) e49

Mesh-Begriff(e)	Pregnancy ; Female ; Humans ; Heart Valve Diseases/diagnostic imaging ; Heart Valve Diseases/epidemiology ; Pregnancy Complications, Cardiovascular/diagnosis
Sprache	Englisch
Erscheinungsdatum	2023-05-16
Erscheinungsland	United States
Dokumenttyp	Letter
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2023.11.023
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Risk Assessment of the Cardiac Pregnant Patient.

Siu, Samuel C / Evans, Kari L / Foley, Michael R

Clinical obstetrics and gynecology

2020 Band 63, Heft 4, Seite(n) 815–827

Abstract: Women with heart disease are at increased risk for maternal and fetal complications in pregnancy. Therefore, all women with heart disease should undergo evaluation and counseling, ideally before conception, or as early in pregnancy as possible. In this ... ...

Abstract	Women with heart disease are at increased risk for maternal and fetal complications in pregnancy. Therefore, all women with heart disease should undergo evaluation and counseling, ideally before conception, or as early in pregnancy as possible. In this article we will review the role of risk assessment, the history of development of the cardiac risk prediction tools, and the role of current cardiac risk prediction tools.
Mesh-Begriff(e)	Female ; Heart Diseases ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Prenatal Care ; Risk Assessment
Sprache	Englisch
Erscheinungsdatum	2020-11-02
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000555
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Trainee selection of tasks in postgraduate medical education: Is there a role for 'cherry-picking' to optimise learning?

Blissett, Sarah / Mensour, Emma / Shaw, Jennifer M / Martin, Leslie / Gauthier, Stephen / de Bruin, Anique / Siu, Samuel / Sibbald, Matt

Medical education

2023 Band 58, Heft 3, Seite(n) 308–317

Abstract: Purpose: Learning is optimised when postgraduate trainees engage in clinical tasks in their zone of proximal development (ZPD). However, workplace learning environments impose additional non-learning goals and additional tasks that may lead to trainees ... ...

Abstract	Purpose: Learning is optimised when postgraduate trainees engage in clinical tasks in their zone of proximal development (ZPD). However, workplace learning environments impose additional non-learning goals and additional tasks that may lead to trainees engaging in tasks that do not fall within their ZPD. We do not fully understand how trainees select clinical tasks in the workplace learning environment. If we knew the goals and factors they consider when selecting a task, we could better equip trainees with strategies to select tasks that maximise learning. We explored how postgraduate trainees select clinical tasks using echocardiography interpretation as a model. Methods: Canadian General Cardiology residents and Echocardiography fellows were invited to participate in semi-structured interviews. Aligning with a theory-informed study, two independent researchers used a deductive, directed content analysis approach to identify codes and themes. Results: Eleven trainees from seven Canadian universities participated (PGY4 = 4, PGY5 = 3, PGY6 = 1 and echocardiography fellows = 3). Goals included learning content, fulfilling assessment criteria and contributing to clinical demands. Trainees switched between goals throughout the day, as it was too effortful for them to engage in tasks within their ZPD at all times. When trainees had sufficient mental effort available, they selected higher complexity tasks that could advance learning content. When available mental effort was low, trainees selected less complex tasks that fulfilled numerically based assessment goals or contributed to clinical demands. Trainees predominantly used perceived complexity of the echocardiogram as a factor to select tasks to achieve their desired goals. Conclusion: Postgraduate trainees select tasks within their ZPD that enable them to maximise learning when they perceive to have sufficient mental effort available and workplace affordances are adequate. These findings can inform individual and systemic strategies to maximise learning when selecting tasks.
Mesh-Begriff(e)	Humans ; Canada ; Learning ; Education, Medical ; Educational Measurement ; Workplace ; Education, Medical, Graduate ; Clinical Competence
Sprache	Englisch
Erscheinungsdatum	2023-07-31
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	195274-2
ISSN	1365-2923 ; 0308-0110
ISSN (online)	1365-2923
ISSN	0308-0110
DOI	10.1111/medu.15180
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Diagnostic Accuracy of Transesophageal Echocardiographic Commissural-Biplane Approach in Identifying Mitral Valve Anatomy.

Abazid, Rami M / Frost, Andrew / Manian, Usha / Patil, Nilkanth C / Bagur, Rodrigo / Siu, Samuel / Chu, Michael W A / Tzemos, Nikolaos

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2023 Band 36, Heft 9, Seite(n) 956–962

Abstract: Background: Transesophageal echocardiography (TEE) conventional multiplane approach (MPA) and the newly proposed commissural-biplane approach (CBA) are the recommended algorithms for identifying the affected mitral valve (MV) segments in the setting of ... ...

Abstract	Background: Transesophageal echocardiography (TEE) conventional multiplane approach (MPA) and the newly proposed commissural-biplane approach (CBA) are the recommended algorithms for identifying the affected mitral valve (MV) segments in the setting of mitral regurgitation. To date, there are no reports to address the diagnostic performance of CBA. In this study we aim to analyze the diagnostic accuracy of CBA and MPA in comparison with three-dimensional echocardiographic findings in patients with severe mitral regurgitation. Methods: We prospectively enrolled 102 patients with severe mitral regurgitation. All patients underwent systematic TEE assessment of MV before surgical intervention to define the affected MV segments/scallops. The standard MPA includes 4-chamber, 2-chamber, long-axis, and commissural views; CBA was performed by obtaining the bicommissural view and simultaneous biplane imaging of the medial, middle, and lateral MV aspects. The findings of both TEE approaches were compared with three-dimensional TEE data to assess the diagnostic accuracy of MPA and CBA. Results: The mean patient age was (65 ± 11) years, and 37 (36.3%) were female. We found that CBA had an overall diagnostic accuracy between 88% and 97% in identifying the abnormal MV scallops; in contrast, MPA accuracy ranged between 82% and 95%. The CBA and MPA were the least accurate in identifying the P3 scallop-88% and 82% respectively; however, both were the most accurate in assessing the A2 segment-95% and 97%, respectively. The sensitivity of identifying commissural abnormalities was 80% with CBA and 30% with MPA. Three-dimensional TEE was found to have a strong agreement with CBA (averaged kappa of 0.81, P < .0001) and a modest agreement with MPA (averaged kappa of 0.61, P < .0001) in identifying abnormal anterior or posterior segments. On the other hand, three-dimensional TEE had a weak agreement with CBA (kappa of 0.43, P < .0001) and no agreement with MPA (kappa of 0.14, P = .153) in the assessment of commissural involvements. Conclusion: The CBA is more accurate than the MPA in the assessment of MV commissural involvement. Given the accuracy differences of the 2 approaches for specific leaflet/scallops, a comprehensive evaluation using both approaches is recommended for all MV scallop assessments.
Mesh-Begriff(e)	Humans ; Female ; Middle Aged ; Aged ; Male ; Echocardiography, Transesophageal/methods ; Mitral Valve/diagnostic imaging ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Mitral Valve Prolapse/surgery ; Echocardiography ; Echocardiography, Three-Dimensional/methods
Sprache	Englisch
Erscheinungsdatum	2023-04-15
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2023.04.008
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Long-Term Cardiovascular Outcomes After Pregnancy in Women With Heart Disease.

Siu, Samuel C / Lee, Douglas S / Rashid, Mohammed / Fang, Jiming / Austin, Peter C / Silversides, Candice K

Journal of the American Heart Association

2021 Band 10, Heft 11, Seite(n) e020584

Abstract: Background Women with heart disease are at risk for pregnancy complications, but their long-term cardiovascular outcomes after pregnancy are not known. Methods and Results We examined long-term cardiovascular outcomes after pregnancy in 1014 consecutive ... ...

Abstract	Background Women with heart disease are at risk for pregnancy complications, but their long-term cardiovascular outcomes after pregnancy are not known. Methods and Results We examined long-term cardiovascular outcomes after pregnancy in 1014 consecutive women with heart disease and a matched group of 2028 women without heart disease. The primary outcome was a composite of mortality, heart failure, atrial fibrillation, stroke, myocardial infarction, or arrhythmia. Secondary outcomes included cardiac procedures and new hypertension or diabetes mellitus. We compared the rates of these outcomes between women with and without heart disease and adjusted for maternal and pregnancy characteristics. We also determined if pregnancy risk prediction tools (CARPREG [Canadian Cardiac Disease in Pregnancy] and World Health Organization) could stratify long-term risks. At 20-year follow-up, a primary outcome occurred in 33.1% of women with heart disease, compared with 2.1% of women without heart disease. Thirty-one percent of women with heart disease required a cardiac procedure. The primary outcome (adjusted hazard ratio, 19.6; 95% CI, 13.8-29.0;
Mesh-Begriff(e)	Adult ; Female ; Follow-Up Studies ; Forecasting ; Heart Diseases/epidemiology ; Humans ; Incidence ; Infant, Newborn ; Male ; Ontario/epidemiology ; Pregnancy ; Pregnancy Complications, Cardiovascular/epidemiology ; Pregnancy Outcome ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Survival Rate/trends
Sprache	Englisch
Erscheinungsdatum	2021-05-25
Erscheinungsland	England
Dokumenttyp	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.120.020584
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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