Laura Divoky, MD, Director of the Women’s Heart Center at Georgia Heart Institute discusses the Women’s Heart Center and its importance to the prevention and treatment of cardiovascular disease within the female demographic at the first inaugural Heart & Vascular Symposium hosted by Georgia Heart Institute at Chateau Elan Resort & Winery in Braselton, Georgia.
I'm passing on the mic now to Doctor Laura Bocchi, who's gonna kick off the second half of our session. Excellent. And we'll hear more from our panel. Um Once we get caught up with our speakers, I know Dr Kronos is vigorously taking notes over here. I'm pretty sure it's not a grocery list. So I'm really excited to hear what your comments are at the end of our uh speeches here. My name is Lord Loki. I'm one of our noninvasive cardiologists here at Georgia Heart Institute and honored to be talking to you about the Women's Heart Center in 2022. I am kind of taking the physician lead for our Georgia Heart Institute Women's Center, but it's really about a team approach. And um I'm behoove to identify my administrative dad, Amy Cut Shaw in the back corner over here who vigorously works to elevate our centers to the next level. So thank you for your dedication and hard work. Amy. I have no disclosure, disclosures. These are my objectives. So why is a women's heart center important? First off, it's because as many of our other speakers have um defined here today, cardiovascular disease is the leading cause of death in the United States for women. According to a survey by the women's heart alliance, in 2014, of women were unaware of that information, which is just shocking. Um even more shocking was that only 42% of cardiologists felt extremely well prepared to be able to assess cardiovascular disease and the specific risk factors and treatments for women. 45% of women canceled appointments with physicians until they lost weight, losing that opportunity for a discussion and intervention and how to help them lose weight. 39% of primary care providers had did had cardiovascular disease as their top concern. So the minority higher priorities were breast health and weight. No wonder women were canceling their appointments until they lost weight as they felt that that was being targeted when they went to their appointment. So that clearly shows that we have a knowledge deficit. This graph shows that it's across ages, it's across income, it's across education level and it's across race and ethnicity because there's a knowledge deficit, there's a treatment deficit if we're not addressing it or even bringing it up as a topic of priority at visits. How are you supposed to early identify risk factors in order to treat it? So, not only are we under diagnosing or under treating and in those women who are diagnosed, they are still under treated compared to their male cohorts, These are just snippets from the guidelines. Um the guidelines specific for prevention and cardiovascular disease in women was last updated in 2011. And then in 2019, we had an update to the guidelines for primary prevention of cardiovascular disease in these publications that delineated some risk factors common to both men and women. Uh including the family history of premature um atherosclerotic disease, Hyperloop idem eah metabolic syndrome, chronic kidney disease, high race, high risk, race and ethnicity, lipid biomarkers and things that are more specific to women are chronic inflammatory disease. As there is a bit higher prevalence of lupus and other autoimmune issues in our female population. And then those um issues specific to women, premature menopause and pregnancy related conditions such as pre eclampsia, gestational diabetes. There's just some targets specific to the prevention of cardiovascular disease in women, looking at different lifestyle modification. So as we're talking about prevention and kind of pivoting a little bit more to women's health here, what are those things that are not medications specific that are gonna make those long term effects and people? Because if we can act on lease, then maybe we can decrease the amount of prescribing of those very long medications. Dr Burkle that you were talking about that. I can barely pronounce, I can just talk to people about stop smoking, exercise more. Um and eat, right? I can talk about that. Anybody can talk about that. So specifically targeting targeting cigarette smoking, physical activity, cardiac rehab. We heard that in an earlier presentation, dietary intake, weight and amongst others. And this is really just a time for a call to action to elevate the level of care for our women out there. There are multiple recent publications on cardiovascular disease in women. Women describing, describing um sex specific um ideologies and ischemic heart disease, the hypertension and pregnancy and the risk that can a cure occur up to 10 years later. What is that the genealogy of cardiovascular disease in women? And uh talking about the access and delivery of care to women with cardiovascular disease. They were, these were all publications um within this year. So women's heart centers frequently partner with cardio obstetrics. There's the alliance for Innovation on maternal health and we've had a meeting recently with R O B team here at Georgia Heart Institute, talking about the Georgia perinatal quality collaborative where the 2022 objective is looking at maternal mortality, um cardiac maternal mortality which occurs in 1% of women. This is just an illustration of some suggestions for what a multidisciplinary cardio structure team would look like for women with a general heart disease. Looking at that preconception care, um which would be contraceptive counseling based baseline cardiovascular assessment, pregnancy risk assessment. Um Looking at the actual pregnancy team, looking at your O B G Y N S, your parents, psychologists, um anesthesiologist, primary care doctors and then different monitoring during pregnancy. If that's a maternal echo of also a fetal echo. Um and just kind of a visualization of what that could potentially look like. So women's Heart center is not a well defined organization. Hopefully in the future, we'll be moving towards like the heart valve team where or the Comprehensive Heart team when we were talking about valve cases, you know, we had collaboration on our live cases um and had the panelists with both interventional cardiologists and cardio uh surgeons. Really, I'd love to see in the future at, at one of these conferences where we're talking about, we have some, you know, concrete scientific evidence that shows the women Heart Center and the collaboration between the different stakeholders, really elevates the level of care for women. It's just really not in the literature at this point in time. So here, you know, we're partnering with our local stakeholders with primary care doctors, O B G by ends with that and autoimmune issues with rheumatologist and really making it a multidisciplinary team. And hopefully here at Georgia Heart will be taking it to the next level and maybe we'll be producing that research that we can present. One day, we want to establish comprehensive here and assessing those sex specific risk factors for women and taking into special consideration, you know, medications and in pregnancy and both in lactation. And that leads to kind of what are some potential. Um Members of the women's heart center, a director, you need that to be just a strong advocate for women's heart help. And I think there's a common misconception that the director and members of a women's heart center has to be a woman. That's definitely not the case. What we need is just a strong advocate, the majority of cardiologists out there are men. So we need all of you out there in the audience to partner with us for this initiative. We need a collaborative approach across discipline. We need to elevate that expectation of how we're going to treat women with cardiovascular care. We need protocols to drive this change. So that way we're diagnosing and treating. We need persistence to continue to move the bar higher and we need to expand our stakeholders. Who on that list that I talked about before, did I not include and who should be on there? The next time I give this talk utilizing our advanced practice practitioners, practice providers here, who they help great uh provide great leadership for members of our women's heart center that provide excellent patient care both in the hospital and in the office, doing both in person and telemedicine options, especially when we're talking about that potential cardio obstetrics component. You know, women go home, they have that frequent care. Then they're like, here's a new human to take care of and why don't you go home and we're not gonna follow you for another six weeks and we hope everything goes just fine um while your hormones are raging, you're not sleeping and you're focusing on someone else and not you. That's why it's a missed opportunity for detecting early um cardiovascular outcomes in the postpartum period. So, utilizing telemedicine, one of the good things I think that came out of the COVID pandemic and now endemic is that telemedicine, wouldn't it be great if we could incorporate that into a home visit, a transition of care visit within that first 7 to 14 days to early detect. So that way things are going wrong and and moms aren't coming into the hospital providing continuity of care and representation on committees such as the Maternal Mortality Review committee, um which is where our advanced practice provider is applying for, for Georgia as part of that initiative and someone just continues to advocate for improvement and change. A pharmacist is an excellent resource for a women's heart center to address those specific issues um with pregnancy, safe and lactation, safe cardiac medications and forming a collaborative practice agreement for chronic disease states. So at the physician level, you can talk about the physician level decisions and then some things where you can have, you know those protocols well delineated and you have a great relationship with your pharmacist. And they can talk about some of these chronic disease states which including but not limited to smoking, cessation, obesity management, diabetes and hypertension, utilizing the dietician to outline at risk eating habits. And and emphasizing I should have put on here emphasizing and congratulating people on the good eating habits too. So giving them that little positive reinforcement while identifying where their riskiest parts are, make goals to improve lifestyle changes and educate um on heart healthy eating. Utilizing an exercise physiologist to assess where their current level of physical activity is any barriers due to previous injuries, surgeries, things like that to formulate individualized programs and set goals. This is just some information again from the Georgia Georgia perinatal quality collaborative showing that the leading cause of pregnancy related death in Georgia was cardiovascular and coronary conditions followed by cardiomyopathy. Hence the goals for 2022. What we're doing with our women's heart center here is utilizing an early risk detecting validated risk calculating score and it's going to be implemented into the O B G by ends. Um Every admitted woman is going to get this screen ideas to trigger a recommendation to a consultation to the women's heart center. And then our nurse practitioner will then go provide in hospital care and then a close transition of care, closing that closing that loop, which I kind of just detailed here is what a streamline, hopefully what a streamline workflow will look like. So in conclusion, just ask you all to join me into the call of action to decrease the disparity in cardiovascular care for women, increase the awareness for risk specifics, risk factors specific to women, cultivate, help cultivate multidisciplinary teams to provide comprehensive care, utilize early detection tools to identify those high risk women work on those workflows to within the women's heart center. To provide efficient care and broaden the workforce used to provide care with medications and beyond. Thank you. Hmm.
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