Journal Series Explores How Eroding Abortion Access Impacts the HF Community

The Journal of Cardiac Failure is launching a series that will explore the intersection of reproductive health and heart failure (HF) care following the loss of federal abortion protections in the United States nearly a year ago.

The series debuted this week with a perspective delving into pregnancy in the context of left ventricular assist device (LVAD) implantation.

Once it became clear that the US Supreme Court would be using the Dobbs v. Jackson Women’s Health Organization case to overturn the 50-year-old Roe v. Wade decision, cardiologists—particularly from the HF community—predicted a detrimental impact on the care of their high-risk patients, many of whom would be placing their lives at risk were they to become pregnant.. Over the ensuing months, concerns have mounted as state-level abortion restrictions continue to spread.

During that time, editors of the Journal of Cardiac Failure (JCF) received a submitted perspective on pregnancy among patients with LVADs, which sparked the idea for a larger series of pieces focused on the care of patients with HF in the post-Roe era, according to Nosheen Reza, MD (University of Pennsylvania, PA), an associate editor of the journal. Now published, the LVAD perspective, with lead author Karen Flores Rosario, MD (Duke University Hospital, Durham, NC), is the first in the series, with several other articles planned for the coming months.

The recurring feature was announced in a JCF “Editor’s Page” article by Reza, Editor-in-Chief Robert Mentz, MD (Duke University Medical Center, Durham, NC), and Deputy Editor Anu Lala, MD (Icahn School of Medicine at Mount Sinai, New York, NY).

“In the process of reviewing the [LVAD] piece, we thought wouldn’t it be great to really expand this conversation and make JCF a home . . . and a platform to facilitate the ongoing dialog and education relevant to the care of our patients across the spectrum of heart failure,” Reza told TCTMD.

Forthcoming perspectives will tackle pregnancy among patients with HF in general, as well as those undergoing heart transplantation, with adult congenital heart disease, and with pulmonary hypertension. There also will be a piece presenting a personal perspective from a trainee, Reza noted, adding that it’s possible the series will expand from there. “I imagine that we would be open to obviously facilitating ongoing dialog in this space, and we’re really interested in what our readership has to say.”

Reza underscored the seriousness of the discussion by noting that cardiovascular disease is a leading cause of maternal mortality, which is already more of a problem in the US than in other developed nations and continues to worsen. The new JCF series is meant to highlight that women with heart failure are at a particularly high risk compared with others, she said.

“We thought it was important to really educate our community on these issues, really provide these kinds of data about why these populations may be at elevated risk if therapeutic options like elective termination are no longer available and how we can modify our practices to mitigate these risks, not only when a pregnant person with heart failure arrives to our clinic but obviously in the processes before that,” Reza said.

In terms of how practice can be changed now, Reza suggested implementation of preconception counseling for all female patients with advanced cardiovascular disease, the generation of evidence to inform specific guidelines around those discussions, and use of innovative care models that facilitate access to family planning clinics as part of an LVAD evaluation, for instance.

“I’m excited to have those themes echoed throughout these pieces, and I think it’s part of our goal to really inspire this conversation about how we can really change for the better the care of all of our patients,” Reza said.

LVADs and Pregnancy

In their perspective, Flores Rosario et al note that about 7% of women with LVADs are of reproductive age, with most implantations used as a bridge to transplantation. Pregnancy is “often considered to be incompatible with durable LVAD therapy, although limited experience has precluded precise quantification of risks,” they add.

They discuss the need, in the current landscape, for reproductive life planning before LVAD implantation and explore how clinical management of these patients may change, including use of interdisciplinary pregnancy-care teams, incorporation of family-planning discussions and preconception counseling, and timely referral to abortion centers for patients with either unwanted or extreme-risk pregnancies.

The perspective authors also make recommendations for how LVAD programs can respond to the new situation and argue for having a framework to guide discussions touching on the intersection of pregnancy and LVADs.

“This article is a call to action,” they say.