Background:

The ACC has long advocated for patients engaging with their doctor and the cardiovascular care team about their heart health and related risks. Shared decision-making is an essential tool in helping to navigate the risks and benefits of all treatment options, taking into account the latest science and medical evidence, social determinants of health, emphasis on health equity, and the patient's own beliefs and goals.

While the ACC has no official policy on abortion, clinical practice guidelines and other clinical guidance tools address the dangers of pregnancy in certain patient populations at higher risk of death or serious cardiac events. As such, the College is deeply concerned about the potential implications of the Supreme Court decision regarding Dobbs vs. Jackson on the ability of patients and clinicians to engage in important shared discussions about maternal health, or to remove previously available health care options, especially given the alarming maternal health crisis in the U.S.

Similar to topics like gun violence that impact the broader medical community and the patients we serve, the ACC will continue to work with the larger House of Medicine to address specific laws and policies as they move forward that would threaten or criminalize patient-clinician discussions regarding maternal cardiovascular care.

Guiding Principles:

ACC's mission is to transform cardiovascular care and improve heart health. We are patient-centered in our decisions and value teamwork, collaboration, professionalism and excellence.

1. Cardiovascular disease is the leading cause of maternal mortality, a substantial and growing problem in the US. A recent study noted a 33% increase in US maternal mortality during the pandemic.
2. Cardiovascular professionals are experts in the care of women with cardiovascular disease who are or may become pregnant.
3. The field of cardio-obstetrics is one of the fastest growing fields in CV medicine, and has developed a growing body of medical science, scientific literature, and practice standards (e.g. JACC five-part Cardio-Obstetrics Focus Seminar).
4. Cardiovascular professionals bear professional responsibility to women with a variety of cardiovascular diseases which may create substantial risk of morbidity and mortality during pregnancy.
5. Our standards of practice include counseling and shared decision-making with our patients regarding use of contraception and pregnancy termination. Important components of these decisions include knowledge of maternal risks associated with certain cardiovascular conditions and patients' values, goals and willingness to take risk. These are among the hardest conversations that we undertake as cardiovascular professionals.
6. We have a common interest in ensuring that cardiovascular professionals can continue to provide optimal cardiovascular care to produce the best possible outcomes for our pregnant patients with cardiovascular disease.
7. The law must allow space for cardiovascular professionals to provide counseling to pregnant patients with cardiovascular disease that includes all medically-appropriate options, as established by medical science and practice standards.

Member Guidance:

1. Cardiovascular professionals caring for pregnant women with heart disease should work in multi-disciplinary teams, with the patient at the center of each team. These teams are more common in large hospital systems or multispecialty clinics.
2. Health care professionals managing the care of pregnant women with cardiovascular disease who are not supported by a large enterprise should consider referring these patients to larger systems with more layers of support and experience.
3. In states currently or imminently restricting abortion, clinicians caring for pregnant women with heart disease should seek the counsel of risk management experts within their system and their hospital staff leadership. They should also work with their state medical societies and state representatives for the American College of Obstetrics and Gynecology (ACOG) to understand the relevant laws in their state.
4. Cardiovascular professionals providing telehealth consultations for pregnant women with cardiovascular disease across state lines should obtain legal support from counsel in the state where the patient resides as well as their home state/institution.
5. Cardiovascular professionals who provide care to women of childbearing age should understand the tools used to predict risk conferred by various types of cardiovascular disease and pregnancy and understand which forms of contraception are safe to use. Clinicians without relevant expertise or experience should identify the cardio-obstetric and women's heart health programs best suited to provide care to their patients.
6. Individual hospitals and health systems should communicate with their state medical societies and ACOG chapters concerning this issue. Angela Shuman, ACC Director of State Government Affairs, and her team can facilitate contact with the state medical society's staff as needed.
7. The ACC's Cardio-Obstetrics Work Group will be developing a set of educational tools that can be used for the following purposes:
   1. Formal educational presentations to colleagues
   2. Educational materials for PCP and ObGyns and other medical team members
   3. Educational materials which can be used to educate elected state officials (via email, social media and in-person visits)
   4. Patient education materials about heart disease and pregnancy risk, cardiovascular health promotion, and wellness

Clinical Topics: Cardiovascular Care Team

Keywords: ACC Advocacy, Pregnancy, United States, Cardiovascular Diseases, Obstetrics, Maternal Mortality, Electronic Mail, Goals, Gun Violence, Gynecology, Health Equity, Leadership, Maternal Health, Pandemics, Pregnant Women, Professionalism, Social Determinants of Health, Social Media, State Government, Supreme Court Decisions, Heart Diseases, Societies, Medical, Risk Assessment, Abortion, Induced, Health Promotion, Patient-Centered Care, Risk Management, Personnel, Hospital, Referral and Consultation, Contraception, Patient Care Team, Counseling, Telemedicine, Hospitals, Morbidity, Policy

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