The survey was sent to a total of 140 physicians, of whom 40 (29%) worked in IM, 43 (31%) in FM, 38 (27%) in cardiology and 19 (13%) in Ob-Gyn. A total of 53 (38%) physicians voluntarily participated in the anonymous survey, with a response rate according to speciality/field of 28% of physicians in IM, 33% in FM, 39% in cardiology and 63% in Ob-Gyn. Survey respondent demographics and proportion of women patients are shown in Table 2. Of these 53 physicians, 11 (21%) were in IM, 14 (26%) in FM, 12 (23%) in Ob-Gyn and 15 (30%) were in cardiology. The total number of years of experience varied among each specialty, however, the majority of physicians had > 10 years of clinical experience. A higher percentage of respondents in IM and Ob-Gyn were women (73 vs. 27% men in IM; 58 vs. 42% men in Ob-Gyn), whereas a higher percentage of respondents in cardiology were men (75 vs. 25% women). There was an equal number of male and female respondents within family medicine. As expected, 100% of the patients were women for Ob-Gyn respondents compared to other specialties (p value < 0.0001). Cardiologists had the lowest percentage of female patients, with 81% of the physicians reporting fewer than 50% women in their patient population. Respondents in both FM and IM reported that approximately 50–100% of their patients were women.
As shown in Fig. 1, the overwhelming majority of physicians aimed to screen their women patients for CVD risk factors, and although most physicians screen often or always for CVD risk factors, 21% of physicians reported only screening sometimes or never. When assessing CVD risk, the majority of physicians in the fields of IM, FM and cardiology did not often ask about APOs, in contrast to the Ob-Gyn physicians, among whom 42% screened every woman and 58% screened often) (Fig. 2). Comparing Ob-Gyn responses regarding screening often or always for APOs to the frequency of screening in the other fields, the difference was highly significant (p < 0.001) (Table 3).
Greater percentages of cardiology and Ob-Gyn physicians were aware of the association between APOs and CVD, compared with IM and FM physicians (Fig. 3) although the results did not reach statistical significance (p value 0.107) (Table 4). Although nearly 69% of cardiologists reported awareness of this association, 56% never asked about APOs when assessing CVD risk (Figs. 2, 3).
Physicians from all specialties were aware that PE and GDM were APOs associated with maternal long-term CVD risk; however, PTB remained consistently under-recognized as being an APO (Tables 5, 6). Furthermore, there remains a lack of knowledge regarding diabetic screening guidelines for women with a history of GDM. The majority of physicians in IM, FM and cardiology incorrectly identified or reported not knowing the frequency at which these women should be screened for diabetes post-partum. Although Ob-Gyn physicians were more knowledgeable about the guidelines compared with physicians in other specialties, they still did not all correctly identify this recommended screening frequency. When assessed by specific APO type, there were no statistical differences in recognition of association with long-term CV risk by specialty (Table 6). There were no statistical differences by specialty regarding screening for diabetes (Table 7).
Within every specialty physicians recognized that women with a history of PE should have annual blood pressure measurement, but they were not aware of the importance of assessing the lipid profile, body mass index and glucose (Tables 8, 9, 10). Physicians from all specialties recognized that women with a history of PE have an increased risk of developing chronic hypertension, stroke and ischemic heart disease; however, many providers were unaware of the associated risk of future heart failure and type 2 diabetes mellitus. Physicians in the fields of IM, FM and cardiology were only slightly familar or not at all familiar with the current AHA and/or ACOG guidelines concerning treatment and follow-up management of women with PE. The majority of Ob-Gyn physicians reported being very familiar with these guidelines (Fig. 4) (Table 11). This difference reached significance when comparing Ob-Gyn physicians to those in other specialties (p < 0.0001).