Stephen C. Cook

Hypertrophic cardiomyopathy (HCM), the most common single-gene cardiovascular disease, is associated with increased risk for arrhythmias, heart failure, and sudden cardiac death. The hemodynamic changes known to occur during pregnancy can exacerbate heart failure and arrhythmias in women with HCM. We present a 30-year-old woman with HCM to illustrate the benefits of multidisciplinary team management of severe left ventricular outflow tract obstruction (peak gradient >100 mmHg) for optimal maternal and fetal outcomes.

Background Physician burnout has many undesirable consequences, including negative impact on patient care delivery and physician career satisfaction. Electronic health records (EHRs) may exacerbate burnout by increasing physician workload. Objective To determine burnout in adult congenital heart disease (ACHD) specialists by assessing stress associated with EHRs. Design Electronic survey study of ACHD providers. Setting Canada and United States. Participants Three hundred eighty‐three ACHD specialists listed on the Adult Congenital Heart Association directory between February and April 2017. Outcome Measures Burnout was measured using the Maslach Burnout Inventory (MBI) to understand factors contributing to work life and EHR satisfaction. Chi‐square and Wilcoxon Rank Sum tests were used for statistical analysis. Results Of the 383 invited participants, 110 (28.7%) completed surveys with the majority (n = 88, 80.7%) reporting from an academic medical center. Burnout was defined as high scores on the emotional exhaustion and/or depersonalization MBI subscales. When comparing the 40% (n = 44) that met criteria for burnout with those that did not, there was strong disagreement that a reasonable amount of time is spent on clerical tasks related to direct (P = .0043) or indirect (P = .0004) patient care. There was strong disagreement that EHRs increased efficiency (P = .006) or the patient portal improved patient care (P = .0215). Finally, physicians who met criteria for burnout had lower personal accomplishment scores (P = .0355). Conclusions Our results suggest time spent on EHRs creates clerical burden exacerbating ACHD physician burnout. The high levels of emotional exhaustion may decrease quality of ACHD care by directing focus away from physician‐patient interaction. Health care systems must develop best practice for EHR design and implementation to optimize patient advocacy and care, and decrease physician burnout.

Purpose of the Review To review the current state of literature on sexual dysfunction in adults with congenital heart disease (ACHD). Recent Findings The prevalence of sexual dysfunction in ACHD is approximately 28%. Compared to age-matched cohorts, the prevalence of sexual dysfunction among ACHD cohorts demonstrates significant variability. ACHD have a lower rate of ever having sexual intercourse and often at a later age. Regardless of complexity, ACHD with sexual dysfunction have higher level of distress, decreased quality of life, and worse New York Heart Association classification. Patients, including heart failure and ACHD, treated with dual angiotensin receptor neprilysin inhibitor have reported improved sexual relationships. Summary The prevalence of sexual dysfunction in ACHD patients is high and sexual dysfunction research in ACHD remains limited. Therefore, the relationship between sexual dysfunction and ACHD remains ill-defined. Cardiologists that participate in the care of these patients should proactively discuss sexual health and provide counseling and therapies to provide high-quality healthcare for ACHD.