Closing the Data and Education Gaps in Cardiac Medication Management

This panel, part of an American College of Cardiology (ACC) initiative, features moderator Jessie Dunne, PharmD, BCPS, BCCP, FACC, a clinical pharmacist at Oregon Health & Science University, as well as panelists:

• Kayle Shapero, MD, PhD, a cardiologist at Brown University Health and assistant professor of medicine at Brown University's Warren Alpert Medical School;
• and Ashley Schenk, PharmD, AACC, BCCP, BCPS, a cardiology clinical pharmacist at University of Kentucky (UK) HealthCare and an adjunct assistant professor at the UK College of Pharmacy.

In this segment, the panelists address that pregnant and lactating patients are hard to study, so much of the available safety data comes from patients who did not realize they were pregnant. Shapero cites a recent retrospective study of glucagon-like peptide-1 receptor agonist exposure as an example, and calls for dedicated studies across cardiovascular drugs, especially in lactation. Schenk points to the lack of standardized training on pregnancy and lactation across health professions. Shapero adds that this gap is what motivated the collaboration among the ACC pharmacy group, the ACC Cardio-Obstetrics Council, and Pharmacy Times.

The panelists support building a registry. Schenk says it could track what medications patients receive and help benchmark management. Shapero is especially interested in prescribing patterns for hypertensive disorders of pregnancy—where clinicians tend to use labetalol and nifedipine—and whether that approach serves patients’ long-term cardiovascular outcomes. The panelists also see a growing role for pharmacists, who often titrate medications in postpartum remote blood pressure monitoring programs and see patients more often than prescribers do. Shapero cautions community pharmacists against telling pregnant patients not to take medications that have well-established safety data, such as certain β-blockers. Leaving a hypertensive disorder untreated can lead to eclampsia. When the data are uncertain, she recommends a risk-benefit conversation with the prescriber instead of a flat “no.”

To support prescribers, the pharmacists encourage learners to practice with Briggs Drugs in Pregnancy and Lactation and LactMed before they need them in a real case. When reviewing a reference, the panelists check whether the data come from humans or animals, whether the animal findings are true red flags, how pregnancy and lactation change a drug’s pharmacokinetics, and whether the evidence goes beyond a few case reports.

For additional guidance, they recommend the European Society of Cardiology guidelines, ACC review papers, and guidance from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. They note that these resources are especially helpful on anticoagulation and hypertension.