The Need

Cardiovascular disease (CVD) is one of the leading causes of death in women in Canada and worldwide. Well-established cardio-metabolic risk factors for CVD remain under-diagnosed and under-treated in women and sex-specific risk enhancers of CVD, such as hypertensive disorders of pregnancy, polycystic ovarian syndrome, premature menopause, among others, remain under-recognized.

Women are also under-represented in clinical trials, making it challenging to advance care and improve outcomes. Even after establishing a diagnosis, women are less likely to receive guideline-directed medical therapy for many cardiac diseases. 

The landscape of cardiovascular pathology in women is continually evolving, which adds to the challenge of providing the best possible care for our patients. Some examples include:

• Women with complex congenital heart disease that now live into their reproductive years
• Increased prevalence, and improved survival of breast cancer, leaving more women at risk of radiation and chemotherapy-related cardiotoxicity
• Emerging role for cardio-obstetrics teams

The Goal

Conducting a pilot program locally will be a strong stepping stone for nationwide adoption of the curriculum to all adult cardiology residency programs across the country, and internationally. It also creates an opportunity to build capacity and transform learners into teachers, and expand and adapt our proposed curriculum to the needs of other related disciplines including internal medicine and family medicine.

Program Highlights

The pilot program spans the three years of the adult cardiology residency training program and includes:

• 25 - 30 hours of multi-modality teaching sessions
• Exposure to leaders in the field from North America
• Post-course examination with questions in a boards-like format
• Access to all recorded sessions online for personal review
• Course evaluation after each session

Extras

1. To support the widespread implementation of this dedicated curriculum across all adult cardiology residency training programs, our team is conducting a National Survey of Cardiologists and Cardiology Trainees on Training and Exposure in Women’s Cardiovascular Health and Cardio-Obstetrics.
2. The pilot program provides a unique opportunity to connect with experts in the field and foster educational, clinical, and research opportunities for trainees. Along with the pilot program, our team will work towards creating a dynamic database of clinical exposures (such as electives) and research opportunities available for trainees across Canada and the US, as available.
3. Our team is working on incorporating simulation-based learning experiences to the pilot program.
4. Knowledge-sharing is important to us and our team is working on providing an open-access, free, user-friendly online platform with our content.

References

1. Vogel B, Acevedo M, Appelman Y, et al. The Lancet Women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397: 2385-2438. 20210516. DOI: 10.1016/s0140-6736(21)00684-x.  

2. Norris CM, Yip CYY, Nerenberg KA, et al. State of the Science in Women's Cardiovascular Disease: A Canadian Perspective on the Influence of Sex and Gender. J Am Heart Assoc 2020; 9: e015634. 20200217. DOI: 10.1161/jaha.119.015634.

3. Norris CM, Yip CYY, Nerenberg KA, et al. Introducing the Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Diseases in Women. CJC Open 2020; 2: 145-150. 20200222. DOI: 10.1016/j.cjco.2020.02.004.

4. Jaffer S, Foulds HJA, Parry M, et al. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem. CJC Open 2021; 3: 1-11. 20201015. DOI: 10.1016/j.cjco.2020.10.009.

5. Pacheco C, Mullen KA, Coutinho T, et al. The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 5: Sex- and Gender-Unique Manifestations of Cardiovascular Disease. CJC Open 2022; 4: 243-262. 20211123. DOI: 10.1016/j.cjco.2021.11.006.

6. Mulvagh SL, Mullen KA, Nerenberg KA, et al. The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman. CJC Open 2022; 4: 115-132. 20210925. DOI: 10.1016/j.cjco.2021.09.013.

7. Parry M, Van Spall HGC, Mullen KA, et al. The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 6: Sex- and Gender-Specific Diagnosis and Treatment. CJC Open 2022; 4: 589-608. 20220419. DOI: 10.1016/j.cjco.2022.04.002.

8. Online webinar. Cardio-obstetrics 101 Building a Program. Natalie Bello, Uri Elkayam, Manisha Gandhi, Kathryn Lindley, Ki Park, Nandita Scott, Mary Norine Walsh. American College of Cardiology. Published December 18, 2020. URL: https://www.acc.org/education-and-meetings/meetings/meeting-items/2020/11/10/16/56/webinar-cardio-obstetrics-101 

9. Lecture at Harvard’s Course - Advancing Cardiovascular Care for Women. Lancet Commission on How to Reduce Global Cardiovascular Disease Burden. Presented by Roxane Mehran, Mount Sinai Professor Of Cardiovascular Clinical Research and Outcomes, Professor of Medicine (Cardiology), and Population Health Science and Policy, Director of Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, USA. May 20, 2022. Online.