In a field often centered around men’s health, one cardiology leader is bringing awareness to an often overlooked pregnancy-associated cardiovascular condition.
Nandita Scott, MD, is director of Mass General Brigham Women’s Heart Health Program and co-director of Massachusetts General Hospital’s Corrigan Women’s Heart Health Program, both based in Boston. She spoke to Becker’s about her efforts to broaden her field’s understanding of pregnancy-associated Spontaneous Coronary Artery Dissection.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How should hospital leaders adapt postpartum care protocols to better support patients with pregnancy-associated Spontaneous Coronary Artery Dissection?
Dr. Nandita Scott: The key is realizing that this population needs nuanced care. The routine way of managing heart attacks needs to be adapted to meet the needs of this population.
A woman who just had a baby, may be breastfeeding or considering having another child is such a change from the usual post-heart attack population that we see, which is typically people with plaque.
Building teams that are sensitive to these specific issues, or at least creating a mechanism where they can refer to the right people, is really important.
This issue just speaks to sex-specific risk factors in general. We were never taught that there was anything unique to women that we needed to think about. When I was in training, we never talked about pregnancy, we never talked about breastfeeding, we never talked about menopause — but all these things clearly affect a woman’s health.
Healthcare systems can incorporate sex-specific training at all role levels, because otherwise we’re ignoring 50% of the population.
Q: You emphasize that contraceptive counseling is “in our lane” for cardiologists managing pregnancy-associated Spontaneous Coronary Artery Dissection. How should health systems build collaborative workflows between cardiology, OB-GYN and primary care to ensure these conversations happen effectively and consistently?
NS: Most cardiologists did not go into cardiology thinking that they were ever going to talk about contraception. The maternal health crisis is a huge problem in our country, and there are many women who probably would do very poorly with pregnancy who need to be counseled against getting pregnant.
If you’re in an abortion-restricted state, there are certain conditions where pregnancy actually risks the mom dying because nobody took the opportunity to describe the risk to her or provide her an opportunity for birth control. As cardiologists, we cannot just say, “Don’t get pregnant and go find birth control.” We need to find a pathway and a solution to do that. Potentially even using the electronic health record, creating a pathway to an automatic referral to gynecology or to their PCP so that can happen.
One of my colleagues here at Mass General is actually working on an Epic pop-up tool that will pop up for any woman who has cardiac disease in pregnancy to then consider whether pregnancy is going to be high risk to make sure that they get access to reliable birth control.
Q: Much about pregnancy-associated Spontaneous Coronary Artery Dissection remains unknown. Are there any promising models or partnerships already showing results in closing these data gaps?
NS: The SCAD Alliance is a national organization actually created by a patient who had SCAD and realized that the medical community had not really done enough to pay attention to this disorder. Through her efforts, she was able to bring together some leaders in the field and also help build on our knowledge.
I’m now on the steering committee of the iSCAD registry. We’re close to enrolling the 2,000th patient, making it one of the largest, if not the largest, SCAD registries around.
Q: As director of Mass General Brigham Women’s Heart Health Program, what do you wish more hospital and health system leaders understood about women’s cardiovascular health?
NS: A lot of people think this is a niche project, but since more than 50% of our population is women, it makes total sense that we create care pathways and protocols that address women’s specific issues. A women’s heart health program is not one female cardiologist seeing female patients. It’s much more than that. It’s understanding the difference in biology between men and women, realizing that women are not just smaller men, and realizing that the impact of our hormones is significant on our vasculature.
Women often make the major healthcare decisions for their household. If you can bring the women in, you will also be impacting their family.
Because the women are doing the grocery shopping, they’re making the appointments — all of that trickles down to the children and the partners.
