The Heart of Motherhood: Women's Cardiovascular Wellness After Pregnancy with Dr. Daniela Crousillat

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Daniela Crousillat to discuss critical aspects of women's cardiovascular health during and after pregnancy. The conversation covers challenges in postpartum care, the role of primary care doctors, and innovative solutions like telehealth. They emphasize the importance of awareness, early intervention, and collaborative community efforts to prevent cardiovascular risks. The hosts also share insights into a recent campaign addressing maternal mortality. The episode encourages women to be proactive, know their health history, and advocate for themselves in medical settings. Overall, it's a concise exploration of women's heart health and preventive measures.

Dr. Daniela Crousillat is a clinical cardiologist and advanced echocardiographer at the University of South Florida where she holds dual faculty appointments as Assistant Professor in the Division of Cardiovascular Sciences as well as the Department of Obstetrics and Gynecology. She completed her undergraduate training at the University of Florida and is a medical graduate of New York University’s School of Medicine. She completed her residency, fellowship, and advanced training in cardiology and echocardiography at Harvard affiliate hospitals, Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, MA.

Dr. Crousillat joined the faculty at USF in 2021 as the founder and director of the Women’s Heart and Cardio-Obstetrics Program. She specializes in the cardiovascular care of women throughout their lifespan with a particular interest in sex-specific risk factors in the prevention and treatment of cardiovascular disease. She additionally cares for women with heart disease through pregnancy and beyond with an interest in pregnancy complications and their role in post-partum heart disease. She has authored multiple peer-reviewed articles, book chapters, and reviews on heart disease in women, and has gained recognition as both a local and national leader in women’s cardiology.

0:00 Welcome back! Guest Intro
2:39 Challenges in Postpartum Follow-up
6:44 Transitioning Care to Primary Care Doctors
10:52 Access to Care
16:01 Postpartum Clinic and Long-Term Care
21:34 Campaign for Maternal Mortality Awareness
27:30 Collaboration and Community Involvement
30:19 Preventive Measures for Cardiovascular Health
35:02 Extension of Medicaid Coverage 
36:43 Closing Remarks & Where to find

Connect with Dr. Kerry Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/Clearwat

Transcript

Kerry: 0:28

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a very special guest, Dr. Daniela Crousillat. Welcome to the podcast. Why don't you tell us a little bit about who you are and what you do?

Daniela: 0:43

Thank you so much for having me. This is super exciting. So I'm currently a cardiologist. I'm an assistant professor at the university of South Florida, and I direct the women's heart program and the cardio obstetrical program. So I am a cardiologist who really specializes in the care of women. And then also in the subset of women who are either thinking about getting pregnant or pregnant, who have a history of heart disease. So that's how I really spent most of my time.

Kerry: 1:08

Well, it's a very unique I guess subspecialty. I was going to ask if you knew how many cardiologists practice in this manner, or is this kind of unique to USF?

Daniela: 1:17

Yeah, that's a great question. So I think slowly and really over the last 10 years, the sort of specialized Women's Heart Center, that sort of paradigm is really growing. Unfortunately, as you probably well known, because you don't know that many places that have this program, it's still sort of a rarity. So it's not that it's available everywhere. I would probably say most states have at least one. Some of them are like, Super populated and have multiple in just one city, for example in Boston, where I came from, where there's multiple providers who have had special training and expertise and specifically women's cardiology. But let's just say, even in the state of Florida, there's probably 3 or 4 all started in the last year. This is really the only one in Hillsborough County and really in the local Tampa Bay area. And I hope that if I'm able to sort of look forward that this is sort of a new trend and that we really start thinking about women differently, what their needs are, what their risks are and start providing sort of more specialized care for women who deserve it and who need it.

Kerry: 2:16

Absolutely. And that's, I think what we're going to focus on talking about today. But can you tell us a little bit how you got into cardiology in the first place? Like what's your path and what drove you to do it?

Daniela: 2:27

Yeah. So, I mean, my my passion for even I would say medicine was giving back to my community and giving back to the most vulnerable. And I think you could take that and put it into any subspecialty. So I really didn't know that I was going to end up in cardiology. I just love cardiology because it was action packed. I'm a very hands on person and I love the physiology. I'm a bit of a physiology nerd. And I was lucky enough now in hindsight to go to a place where that had a women's heart program. It wasn't even something I was looking for. And I was lucky that I had wonderful female mentors and I saw them doing fantastic things. And it was as basic as you know, women are really 50 percent of the people that most people see in their practice, but thinking about them in a different lens listening to them, valuing their symptoms and figuring out how are they a little bit different than sort of the way that we sort of blanket treat everybody else. And I got on that boat very quickly To give back to a quote unquote vulnerable community, which is really, most of the women that we see, but particularly in the world of cardiology, when you think back, it's really sort of known as a man's disease. They think it only happens to older people. People think it only happens to men. And the reality is that we started realizing that it really was a woman's problem too. And it's still the number one killer for women. So when I sort of put that all together, I said, well, I really went into medicine because I wanted to get back to my community. And I said, what a better way to really get back to women, a vulnerable group of women who are at risk for heart disease and otherwise wouldn't get that specialized care. So, I feel like it kind of came full circle. There's different ways of giving back. There's different vulnerable populations, but this was sort of particular 1 that really ignited my interests. And I felt like I could devote my career and many years to improving the care of women everywhere.

Kerry: 4:19

Yeah, I love that. You bring up so many good points of that sometimes, you know, men, women, we have different physiology and different terms in our life that happen. And I know specifically you do a lot of like maternal medicine, and that's a whole nother unique part that of processes that we go through. Like you said, you're a physiology nerd and what more complex physiology than maternal cardiac problems and things like that. So what you're doing is so neat and unique, and I think it's amazing. So did you help establish the joint cardio obstetrics program at USF. So this is brand new, right?

Daniela: 4:55

Yeah, I did. That's absolutely right. So they had a cardiovascular program where I trained and I was lucky enough I soaked everything up like a sponge. I still, honestly, those are my mentors and collaborators and people who have helped me to start it here. But it was important for me. I have family in Florida and I have roots in Florida. And it was really cool for me to say, why don't I pick up everything that I've learned and bring it to a place that doesn't just doesn't have that level of expertise and bring it to community where it doesn't exist. So I was lucky enough to be recruited to come down here in 2021. It's sort of a joint program between the University of South Florida and Tampa General Hospital. And the cardiovascular program that you talk about lives under sort of the more general women's heart programs. Of course, we'll see women all throughout their lifespan, but we do have a special program and also clinic that we host once a week in conjunction. So it's an OBGYN or a high risk doctor called a maternal fetal medicine doc because I am not some people think I'm an OBGYN too, which is like a total myth. Like, no, thank you. I stay on the cardiology side, but we see them in clinic together. So these are women that have heart disease or at risk for it who want to get pregnant or already pregnant. And we see them sort of through our program, follow them through again, caring for both mom and baby together. And many of them go on to sort of continue care through the more generalized women's heart program throughout their lifetime. So I love that you sort of highlight the hormone, the physiology, all those things, because people think of pregnancy as such a normal part of life, but there's definitely complications and things in pregnancy that we now consider sort of a window into what a woman's future health could look like. It's important to highlight that piece of it, the sort of pregnancy or more reproductive years piece and how that plays into future health for women.

Kerry: 6:43

Well, I thought we were going both directions here, but I do you want to continue on the general women's heart health direction or do you want to go? Okay. I didn't know if we should just switch it.

Daniela: 6:52

Yeah.

Kerry: 6:53

all right. So just tell me like the what are these sex specific issues that women have that makes them at risk for cardiovascular problems?

Daniela: 7:02

Yeah. So I think when I think of what makes women different in terms of the risk for heart disease, I think of sort of two different things. One, there's some underlying, let's say, diseases that are more common in women. I'll give you an example. Things like autoimmune disease, like lupus or maybe rheumatoid arthritis. Maybe even things like oncological stuff like breast cancer. And we now know that getting radiation for breast cancer or getting certain kinds of chemotherapy that can be toxic for the heart. In women who have breast cancer, that increases the risk for heart disease, or for example, things like lupus and rheumatoid arthritis, they're sort of thought to be these inflammatory diseases. And now we know that a lot of heart disease comes from having too much inflammation. So again, the rheumatological diseases and things like breast cancer are more prevalent in women. So if you're not asking the right questions or taking those things into account, like, Oh, does my patient have, you know, lupus and thinking about that and how that increases the risk for heart disease, you're totally going to miss that. If you're used to just screening for the run of the mill things that, again, we should be screening everyone for high blood pressure, diabetes, are you a smoker? Those kinds of things. So those are not necessarily sex specific, but I would say more sex prevalent and linked to heart disease. Now there's the other bucket, which are the sex specific, right? They're like, we get so lucky, I guess, or unlucky that we have certain things that men will not experience in their lifetime. And that can be things that start from a young age. So things like having polycystic ovarian syndrome. Or having the onset of menses or what we call monarchy too late or too early having difficulty getting pregnant, things like infertility and then things that happen in actual pregnancy. So, like delivering a baby too early before the age of 37 weeks, having that high blood pressure associated with pregnancy that people call gestational hypertension or preeclampsia or even failing that dreaded glucose test that people take through pregnancy to see if they develop that kind of pregnancy associated diabetes, all those things independently like by themselves have been linked to having a future risk of higher heart disease and women who have those complications. So when I think about this in the women that I see, it's important to ask the right questions, right? If we don't ask the right questions, so appropriately screen a woman for, you know, what is the risk of having heart disease? Not now, maybe, but 30 years from now, we really have to advocate for making sure that we're asking the right questions that include both sex prevalent diseases, as I talked about it first, but also the more sets specific ones that could easily be missed. And women can just be waved off. It's like, you're probably okay. Your risk of heart disease is low if those risk factors are not taken into account.

Kerry: 9:58

So even just having had some of these conditions, like say either one they're under control or like maybe you had diagnosed with PCOS and then you- you know, not having any problems later, that is still a risk of for having heart disease way down the line.

Daniela: 10:13

We still consider those as risk factors. And I know there's sort of a lot of them but even I think all of them independently have really panned out. So I'll give you sort of an example. For women who have, let's say, preeclampsia with any pregnancy, the risk of having things like heart failure in the future is probably four times as much as a woman who had pregnancies who didn't have preeclampsia. Or the other example is when we take. women who have had a preeclampsia, so again, the high blood pressure in pregnancy, and we scan them, you know, there's now all these coronary calcium and like, how do you figure out if you already have coronary artery disease? When we scan those women, like between the ages of 40 and 50, the ones that have preeclampsia in their pregnancies tend to have already Some calcium deposition in their arteries compared to women that haven't. So we are very gentle and kind. We never want to freak out 20 and 30 year olds who are in the most like beautiful part of their life and having babies and going home with them. But we do do a lot of education upfront. Because we think that by educating and empowering women in their 20s and 30s and knowing that they have some risk that they should then continue to tell their longitudinal primary care providers that will help us figure out, you know, or that will help us better assess what their future risk of heart disease is. I think they're just often missed, or I think that people just don't know about that association. So I think starting from the Very beginning in women who are 20s and 30s and educating them, educating our providers and our community about what these risk factors are is really, really important.

Kerry: 11:46

So you've mentioned all the risk factors. What are the things that you like kind of partner with the primary care provider going forward of what do they do

Daniela: 11:54

I know it's a great question. You're like, well, we know all this. What do we do? So I think they're is a role in doing sort of earlier cardiovascular risk stratification. A lot of that is the routine, I think, run of the mill, what most primary care physicians would do. They're checking, they're screening, maybe they would screen earlier or screen more frequently for things like diabetes if they had what we call gestational diabetes. Maybe, you know, this is the time when like women don't really see their providers or a lot of them don't. They see their OB as their primary care doctor because they have to, to be able to get through a pregnancy. And then many of them are just kind of lost until either something happens or they re engage with care in their forties and fifties. And that's just a reality, but they really do need to be having check ins. Like they need to be screened for high blood pressure and start on appropriate medications. They need to be screened for diabetes with hemoglobin A1c. No one really follows women in their trajectory in terms of weight gain, which we know obesity is one of the biggest risk factors we see in the post part of weight retention is an issue for everybody. And it's just a time when they're not in care. I think the world of obesity medicine is really evolving and there's new therapies that can help and those are now being studied, particularly postpartum and women who, would potentially be candidates for that as a way to reduce their overall risk of heart disease. So I have to say there's no special test. There's no special drug or medication that we say, Hey, you've had preeclampsia we're going to give you this. This is going to keep you healthy and safe. But I think in terms of when we think of risk stratification, or even women having symptoms that are ignored. If they know that they've had a background and they have an increased risk of heart disease, it's really a discussion. So I think where we're at now is education and awareness. I think hopefully in the next sort of five to 10 years ongoing studies will help us figure out like, okay, now we know we have this is there any way for us to either minimize or reduce that risk that we know you have? And is that a treatment? Is it scanning everyone at age, I don't know, you name it 45 or 50, but to directly answer your question, there's no current sort of evidence based guideline that says all women who had this should get this by this age. So that's really where the gap exists, but that for me, gaps are like areas of like where we just need to do more work.

Kerry: 14:17

Well, here's what I propose. You mentioned you study nutrition right at University of Florida. So why are those patients not given like those kind of counseling measures or maybe that's what they need, right? Because if they're having preeclampsia or having gestational diabetes. Or had PCOS and infertility problems in the first place. Those are those insulin insulin resistance factors. Probably obesity is part of could be part of the problem. Maybe not, but I mean, catching them before they get lost to follow up after they've delivered is a huge thing. So maybe it's that the obese actually need to partner with like the primary care providers to get the message across. Now I've got some-

Daniela: 14:58

love that people don't say that enough.

Kerry: 15:01

Yeah, because I've got some patients that they're OB. You're like, Oh, you need to go find a primary care provider because your blood pressure is still high in the postpartum period, but what about the ones where it did go right back to normal? Here's your six week follow from OB, you know, see when you have a problem, like that's what I think is, you mentioned is some great thing. So I feel like it makes me want to reach out to OB doctors, right. And say, Hey, listen, if you're having a patient with this, this, this, this, or have, some sort of complication of pregnancy regarding that, like, let's not let them get lost to follow up. Right.

Daniela: 15:33

bring up. Fantastic points. So I call a year after someone delivers the fourth trimester. I think that pregnancy is like not that long, but it's the most vulnerable period and I don't want to say in a woman's lifetime. That would be totally inaccurate, but it's a vulnerable period for many of the things that you exactly mentioned. One, they're like home with their newborn and like, it's hard to make appointments. It is now you have childcare or you bring them, you lug them with you, transportation, new responsibilities, going back to work. I mean, it just runs the gamut. So unfortunately, our rates of follow up are actually, that's where we struggle. And that's where I think we need to be innovative about like, yeah. Is it telemedicine? Is it like getting care at home? Is it community health workers? Like, how do we reach women during a period that we know is vulnerable? And then where really primary care doctors come in is how do we transition care? I get it. Look, half my friends are obese. Half of them are cardiologists. The obese are like, they have their baby. We're done. And really, after that six, eight week check in, that's sort of like it. And they encourage them to find someone, but I'm a patient like all other people and I've tried to pick up the phone and try to get a new primary care doctor when I first moved to Tampa. And some places were like not taking new patients. We can see you in a year. So it's also not easy to sort of what I call plug and play, right? Like, okay, find a new primary care doctor. Thank you. I have a jillion things on my plate and a newborn baby, right? So there's really, I think an absence of care. It's not even that bad care is being provided. It's that there is a lull kind of like after they deliver and they get their check and there's really not a good either warm collaboration or a good system to really go from either OB to a primary care doctor. So we do have a postpartum clinic here that sees patients at two weeks at six weeks and then at three months. The hope is that at three months and you've already been talking to him about like if you have a friendly PCP, this is the time to reach out to them and maybe schedule a six month visit postpartum and really our role is we can't hold on to every mom that has had a pregnancy complication. But We can help in getting that started with the education awareness, checking their blood pressures or repeating that glucose test, and then sort of doing a warm handoff to their long term and more longitudinal primary care provider, or even assisting them in finding someone. I think access to care is the biggest thing.

Kerry: 18:00

hmm. Yeah. I mean, certainly access to care. And I think you mentioned a great thing. Telehealth. It was funny. I just interviewed someone all about telehealth. So, I mean, I think that it could be a possible solution. One of the specific populations that we talked about in that was new moms or moms that, you know, can't get to appointments. And honestly, like during that period, there's so many pediatric appointments that you have to be going to. And it's overwhelming to even think about yourself. Right. Yeah. Yeah. Or to worry about

Daniela: 18:27

yourself Yeah. People have thought about pairing, like, baby visits with mom visits, you know, they're going to show up for that, like, two week. They need their shot visit or like the they're more likely to show up, I think, for their baby than themselves, which is just, I think, how women are wired,

Kerry: 18:43

Yeah.

Daniela: 18:43

not at fault. But yeah, I think this is a place where we need a little bit of innovation. a little bit of like, how do we meet and support the needs of our moms? And if it's telemedicine, then hey, we learned how to do that really well with the COVID pandemic. So maybe this is a patient population where like, it needs to be primary, you know, telehealth and in person when needed, right? Sometimes you just need an in person visit. And that's okay. And one of the things I would say is since COVID. There has been an extension of Medicaid in the state of Florida for one year postpartum. So it used to be in a lot of states, including in Florida, that women would only get care for like six to eight weeks after they delivered, which is like, you know, part of the big access to care issue. Not only is like, you know, hard showing up and going on an appointment, but if you don't have healthcare coverage, then it makes it like nearly impossible. So for the past, at least a year, if not a little bit longer. So that sort of that got extended This is a window of opportunity for people like me who like to think about access to care, innovative strategies, and how do we give these vulnerable populations the care they need. A large majority, or a good, I would say a good chunk of the women that we care for in the postpartum period. Now actually have accessibility, at least from the insurance standpoint, to actually continue to get care through 12 months. So now we just need to be savvy about how to use that cupboards and how to get them in.

Kerry: 20:12

Well, that's great to know because I was actually going to bring up, like when I trained in Baltimore, we had to do an OB like a certain amount of deliveries and everything, and I specifically remember that they did not have coverage except for when they were pregnant and I was going to say, well, then there's that other gap where these people aren't even insured to have care after they deliver their baby. But I didn't, I didn't know it was extended. So that's helpful. Certainly there's needs more answers. But yeah,

Daniela: 20:40

But helpful. I think it's 37 out of 50 states or maybe even higher now. I don't keep up with that stuff all the time. But as someone who's been living and practicing in Florida the last three years, it was a move definitely for us in this realm of like in the right direction, because I think a lot of care should be provided in that first year. So it's definitely a yay. Now we just got to figure out how we do it.

Kerry: 21:01

What other ways can women do to keep themselves healthy to prevent these cardiovascular outcomes? And what are they, what are we talking about? Anyway, in case for our listeners, what are these cardiovascular outcomes that we're talking about? We talked about the risk factors, but we didn't really say what we're talking about.

Daniela: 21:16

Yeah. So when we, you know, we sort of use the blanket term heart disease, which is sort of like, what does that mean? Typically we talk about things of risk of a heart attack or what people call myocardial infarction risk of a stroke, which kind of comes hand in hand. Risk of heart failure. And then obviously I think like risk of death is on there because of course, cardiovascular disease is the number one cause of death for women. It's also the number one cause of death after women deliver so although we don't like to talk about that it's a reality. And really the, the counseling for all of those and the things that we know work right to try and prevent or reduce someone's risk of that blanket statement of heart disease probably spans all the different things we talked about, whether it's a heart attack, a stroke, or dying from cardiovascular disease, the sort of heart healthy suggestions that we make and the counseling we do really span the whole umbrella. So it's not like I'm going to do this to prevent a stroke, but I'm going to do that to prevent a heart attack. Thank God it's not that complicated. So the most important thing that women can do is have be educated and have increased awareness of what they think the risk is for heart disease. So I say that because I think they need to know what the true risk factors are that affect them specifically other than the traditional ones, high blood pressure, diabetes, smoking, and they need to also empower everyone to talk to their family. I know it's not like your most greatest conversation over the dinner table, but the reality is it's important to know if there's someone who's died suddenly in your family, if someone had open heart surgery for a bypass, what mom and dad, and maybe even brothers, sisters, siblings, and all first degree relatives, not intricacies about it, but if there's anything that kind of strikes a tone for something being genetic or something that quote unquote runs in your family, even high cholesterol, all those things are actually helpful to know. And they help us too, right? Because again, it's just an additional thing that makes us say, Oh, maybe this person is a little higher risk than what they are. So really, it's about asking the right questions, knowing your own personal history, including your reproductive history, but also knowing your family history. I empower all women to either know that or try to sort of search to give us better knowledge. And then the stuff that I'm sure you do so well in your clinic, and then hopefully all of us counsel, the hardest things to do, which are really, lifestyle modification, which are things, you know counseling surrounding exercise, sleep, and I'll say a word about that, nutrition, not smoking, either picking it up or complete smoking cessation. All those things are really the hallmark of prevention when it comes to cardiac disease. I mentioned sleep specifically because the American Heart Association used to have these, like, life's simple seven. If you do these 7 things Like I just named, I think I got all seven, but maybe I got five you will be great. And then last year they rolled out their new campaign and they increased that to eight and the eight became sleep. So they're sort of growing, yeah, growing data and research to suggest that like not good sleep patterns, not getting enough sleep, sleep apnea, all these things that sort of disturb your sleep again, sort of increase the risk of someone's heart disease. So I know it's like add one more thing of the things that we need to screen for right now. We got to talk about sleep too. So I feel like unfortunately they keep adding to the list, but they don't subtract making our work as clinicians a little bit, a little bit harder, but all those things should still remain the focus. If the focus can be done earlier like when you're in your 20s or 30s, that would be golden. Unfortunately, people start to think about like achieving a healthier weight or like eating a little bit more healthy or getting more exercise sometimes it happens, in like the 50, 60, 70s. It doesn't mean we should deter them, but I think the earlier, the better, which is sort of the reason why we think of our young reproductive age women is like a window of opportunity. Can we shift the tide? Right? Can we change the landscape? Can we minimize the risk of future heart disease among our communities? And I think that's where we should focus our efforts on the earlier prevention.

Kerry: 25:32

Yeah, obviously, if you're preventing it earlier, then you're going to have less of that plaque build up and less of, you know, anything else, but I mean, starting it earlier and then also just like learning those habits that need to maybe be tweaked a little bit to set in turn for long term longevity, right? You can combat some of their risk factors that you mentioned genetic wise with doing that. Definitely important things that people can turn their whole health around. So how do you get involved with the community? I mean, you mentioned that you, try to do a lot of community outreach and everything. What are some key steps that you do or can do to improve women's cardiovascular health?

Daniela: 26:15

Yeah, that's a great question. I think about that all the time because I think we can't just like sit in an office and expect the tide to change. You know what I mean? So I'm a big just advocate for women to know that this is a thing. So I partner with, local stakeholders, community groups, people like the American Heart Association, which provide a really great platform for just like getting the word out there. And every time I either see a patient in clinic or I talk to them or we have some community outreach groups where we give, talks that are for patients and not for physicians, not a lecture, but just like a, this is what you need to know. And these are sort of the facts I always encourage everyone to just talk to one other person. Cause I think there's really power in numbers, right? So I may have seen 10 patients in clinic today, but if. The women that I see just, you know, tell one of their girlfriends next time they're out shopping or at a dinner like, Hey listen, I'm seeing a cardiologist. Like heart disease is something that's that can happen to women too, you know, and we should be, you know, heart healthy and worried about those things. And I think that's how things sort of spread. So I definitely try to do that on a day to day and any sort of encounter, I'm like, tell a friend, tag a friend, or bring a friend to the next sort of event or function or something that we're doing. Again, the awareness piece, any opportunity I get to either do things like this, a podcast for the Tampa Bay area. I'm like, this is fantastic. But whether it's like lectures for physicians, whether we hold dinners whether I work with the American heart association, there's some maternal groups to like healthy start and reach up that, you know, already have been working on this for years. So I'm not here to much. Recreate the wheel. I'm really here to sort of try and bridge partnerships and support collaborations, because I think this is not one person's job. I think this is the kind of thing that the more people that are enthusiastic about it, passionate and want to sort of change the tide for the health of the women in our community so I still think we have a long way to go, I think definitely have made some progress. Part of my sort of, you know, outside of me being a cardiologist and specializing in women is really empowering other women who are also, you know, they don't have to be physicians or clinicians, but we have close collaborations with the School of Public Health at the University of South Florida School of Nursing. It's really just allied providers. It's anybody who wants and cares about the health of women in the community, I think are also sort of good collaborators to have. We're really trying to start a revolution here on this side of town. And I know that I can't do all the work by myself. So I'm always very keen on collaborating with others and making anything that opens up our ability to reach people in different places. I'm trying to think of the most recent one. There's a group that's doing like mobile care units. I think it's literally like a little van that goes to neighborhoods that are vulnerable for different reasons. They have poor access to care and things like that. And even they were like, can we can you come up with some sort of like little pamphlet or something that we can give? Like, we just want to again, not scare anyone, but just sort of highlight it as one of the things that maybe we provide counseling for in that high risk community. I'm like, that's fantastic, right? It's just one additional opportunity to reach a different set of the population that maybe otherwise wouldn't hear or know about things like that.

Kerry: 29:51

What, what was, you had a recent campaign that you were doing this fall. What was that all about?

Daniela: 29:56

Yeah.

Kerry: 29:56

want to share the

Daniela: 29:57

So I got nominated to be a leader of impact for the Tampa Bay community. You're probably like, what does that mean? I also didn't know what it was, but it's a big sort of fundraising campaign for the American heart association. But they let you sort of make the campaign about something that is special to you. And I built sort of the whole campaign surrounding maternal mortality. Unfortunately, as I sort of mentioned before, heart diseases it's still the number one causes why women die either in pregnancy or in the year after they deliver, which honestly is quite scary. But when we look at all the deaths and there's like big committees, the state of Florida has one, but every other state and the CDC who get together after somebody dies and they take a look, like why. Was it something that could have been done that this just happened because it was terrible luck and that's the way life is. And the reality is like 80 percent of them are preventable deaths. So that says a lot to somebody like me working in the maternal and cardiac world. If 80 percent of the deaths in women are preventable, then that means that we have some wiggle room, right? And also a lot of room for improvement to try and prevent that from happening. So the recent campaign, which went from September through the end of November was really to highlight that for our community, because I think people were shocked when they heard that cardiac disease doesn't just kill women, but it can also do that in young women after they deliver, which is a horrible and unfortunate event. But I try to highlight is like, we have a lot of work to do. And this is preventable to get sort of people again, increase awareness and get people excited about promoting this. So I won the AHA Leader of Impact Campaign, which I'm really, really excited about. Thank you. I just found out it's like fresh off the press. And honestly, I see it as just another platform, which hopefully you'll realize after listening to the podcast today, like any, any platform, any opportunity, even things like this in the podcast, it's just one extra avenue to reach, different parts of the Of the population.

Kerry: 31:59

And to be clear, you said 80 percent but of postpartum maternal mortality, right? Or

Daniela: 32:05

Great question. 80 percent of so when we say maternal mortality, it includes during the time that you're pregnant to 12 months after people deliver, they kind of and maybe 50 percent of them happen after women deliver 80 percent of those are preventable. Yeah. Yeah.

Kerry: 32:24

most common causes?

Daniela: 32:26

Yeah. So it tends to be cardiomyopathy. I think if you look five, 10 years ago, women were dying from things like infection and bleeding, which like kind of makes sense, right? Like there's a risk of bleeding after the baby comes out, they call that postpartum hemorrhage or there's a risk of infection, particularly when women have C sections and those are really the highest risks. And then in the last sort of 10 years, the cardiac causes have come up. In the state of Florida, it's complications from high blood pressure from hypertension. So things like severe preeclampsia and cardiomyopathy. Those two are probably the top two quote unquote cardiac diagnosis that fit that bill and You're right that, you know, some women are like, well, how can I prevent that? I can just get preeclampsia without even, you know, like, it's just the thing that kind of happens. And it's true. Sometimes it just happens to women without many risk factors or who have had an uncomplicated pregnancy. And cardiomyopathy is the same. Some women have a history of it and then they happen to get pregnant. We're lucky because we know about that kind, so we can watch it and we can treat them. But there is a cardiomyopathy that happens from the stress of the pregnancy being too much on the heart. And we call that peripartum cardiomyopathy. And that just means that the heart gets fatigued because the stress of the pregnancy is too much on the woman. And those women tend to get that diagnosis in the third trimester, like very late on, or actually the most common is in the first couple of weeks postpartum. And again, like if they're not seeing their provider. If their healthcare insurance has been like cut off like it is in some states, if they don't know the symptoms, like some people don't even know your heart can get fatigued, from a pregnancy or they, you know, those are all reasons as to why potentially some of these cardiac conditions or events can be missed during that vulnerable fourth trimester.

Kerry: 34:14

So the 80%, sorry to clarify one more time, was for all maternal mortality, not just cardiac reasons.

Daniela: 34:21

Correct. Okay. Good question. 80 percent is for all of them. Infection, bleeding, cardiac. The maternal ones, we think 20 to 30 percent are preventable. Good question.

Kerry: 34:33

you mean the cardiac one?

Daniela: 34:35

the cardiac ones are 20 to 30%. So all comers, why are people dying? 80 percent of them are preventable. If you look under just the cardiac ones, preeclampsia, cardiomyopathy, I don't know, blood clots, stroke, it's all kind of clumped together as cardiovascular. 20 to 30 percent of those are probably preventable. Good clarification.

Kerry: 34:55

Okay. I'm learning too here,

Daniela: 34:57

Yes. It's okay.

Kerry: 35:00

Well, is there anything else you'd like to share with the listeners today?

Daniela: 35:04

No, I would say my, my bottom line is just to empower people to know their personal history, to talk to their families and to advocate for yourself. When you see your physicians, I think that's the most important thing. So if something's feeling off to women, if they think that there's something that. You know a piece of their personal family history, reproductive history that they think is important, that that's something that they should encourage them to talk to their providers about typically, you know, I, I feel like our first line of defense is their primary care physicians and their general practitioners, but just to, to know, I feel like know your history, know the facts and then do your best. This is not a time to get scared or be in fear, but just know your best and try to live a heart healthy life as possible.

Kerry: 35:50

I like that. I really thank you for everything that you do for women's heart health and just everything, especially with the combined obstetric side of it at USF. I mean, I think this is amazing. And it definitely like a much needed area and it's really important. And so thank you for what you do. And thank you for coming on the podcast

Daniela: 36:09

Absolutely. Thank you for having me.

Kerry: 36:12

Okay. All right, everybody. That's it for today. We'll see you next week. Thank you so much for joining us. And I forgot to ask if, is there any link or anything that people can find you on? Or do you do anything?

Daniela: 36:24

I'm not on social media that much. I do have a Twitter account, which you're welcome to share. And then we do have a website for our Tampa general, both the women's heart program and the cardiovascular program as well.

Kerry: 36:36

perfect. Okay. We'll put all that in the show notes and everything.

Daniela: 36:39

Wonderful.

Kerry: 36:40

All right. Thank you so much for being on the podcast

Daniela: 36:43

Absolutely. Thank you.