Inaugural Midwest WIC Symposium

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The first Regional Midwest ACC Women in Cardiology (WIC) Section conference was held this past September in St. Louis, MO, and was supported by the ACC Arkansas, Kansas, Kentucky, Missouri and Oklahoma Chapters.

Heart disease is the leading cause of death in women in the U.S. However, both health care providers and women continue to underestimate cardiovascular risk for women, leading to underutilization of preventive therapies. This fueled the need for the symposium as a platform to share knowledge and best practices with all clinicians who care for female patients with the ultimate goal of improving the cardiovascular health of women. The goal was to improve competence in the diagnosis and treatment of women at risk for cardiovascular disease, with a focus on imaging, caring for the pregnant patient and identifying controversies in the latest clinical trials. This course was specifically designed for cardiologists, internists, primary care physicians, physician assistants, nurse practitioners and other health care providers.

The symposium kicked off with an informal Meet and Greet Networking Cocktail Reception at the Chase Park Plaza Hotel. It was a great opportunity for the attendees to talk and get to know the faculty. The next day, attendees were welcomed by Toniya Singh, MBBS, FACC, chair-elect for the ACC WIC Committee and Claire S. Duvernoy, MD, FACC, chair of the ACC WIC Section. Next, an excellent and informative keynote address by Annabelle S. Volgman, MD, FACC, director of the Rush Heart Center for Women, discussed the epidemiology of atrial fibrillation (AFib) from a gender standpoint. She pointed out that women have a higher risk of stroke, which is compounded by multiple factors including advanced age, diastolic dysfunction, worse outcomes with warfarin and the reluctance to use novel anticoagulants. She also drew attention to the fact that women were treated with digoxin more frequently than men, and discussed the evidence of increased risk of breast cancer with use of digoxin in patients with AFib.

The following topic for discussion on the agenda was a "state-of-the-art imaging update." This session included case-based discussions on hypertrophic obstructive cardiomyopathy and was led by Sharon Cresci, MD, FACC; Krishna Patel, MD; Nishath Quader, MD, FACC; and Hena Patel, MD. Next, we discussed updates in the care of the pregnant patient, which was moderated by Kathryn Lindley, MD, FACC, assistant professor of medicine at the Washington University School of Medicine. Laura Schmidt, MD, then discussed the CARPREG score, which estimates risk of cardiac complications in women with acquired or congenital heart disease (CHD) and arrhythmias. She also discussed the ZAHARA score, which predicts risk of complications in women in CHD for maternal complications like significant arrhythmia, heart failure, endocarditis and neonatal risks of premature births, and mortality.

Anna Grodzinsky, MD, reviewed existing data and registries, including the European Registry of Pregnancy and Cardiac Disease database investigating cardiac disease in pregnancy. She also outlined the vision for establishing the first U.S. multisite cardiac disease in pregnancy registry – the HOPE for Mom and Baby (Heart Outcomes in Pregnancy: Expectations for Mom and Baby) registry.

Karen Florio, DO, provided an obstetrician view of the gravid cardiac patient. She highlighted the physiologic changes in pregnancy, risk stratification of cardiovascular diseases in pregnancy, peripartum monitoring recommendations and importance of not shying away from discussing contraception with the patient. Gretchen L. Wells, MD, PhD, FACC, professor of medicine at the University of Kentucky, shared information on hypertensive disorders in pregnancy and how to manage them effectively.

After the lunch break, care and wellness for the cardiologist was the topic of discussion, and Lorrel E. Brown, MD, FACC, shared her story of resilience. Her story was honest, humorous and plucked at our heart strings. Brown made us laugh, cry and nod our heads at our shared experiences. Her speech was met with a standing ovation and a thunderous applause.

The last session for the symposium included discussion on current controversies in cardiology as Marye J. Gleva, MD, FACC, and Jane Chen, MD, FACC, engaged in a debate about the pros and cons of the VEST trial. This debate was followed by another thought provoking session by Dee Wang, MD, FACC, and Lisa Alderson, MD, FACC, discussing the pros and cons of PFO closure. For the final topic of the day, Sabeeda Kadavath, MD, provided review of recent clinical trials from ESC Congress impacting clinical practice in 2018.

The meeting audience was completely engaged and the energy in the room was electric. The symposium provided an excellent mix of networking, camaraderie and information. There is now much enthusiasm for creating a recurrent annual meeting, with the goal of taking the meeting to each of the Midwestern states.

This article was authored by Sabeeda Kadavath, MD, Fellow in Training (FIT) at the University of Arkansas for Medical Sciences in Little Rock, AR.