Faculty Spotlight: Megan McLaughlin, MD

 

Improving Health at the Crossroads

“I really enjoy working at the intersection of two different specialties,” said Megan McLaughlin, MD, MPH. “I learn so much from my colleagues, and engage in fruitful collaboration around a problem that involves both our specialties.”

Dr. McLaughlin’s many clinical and scholarly interests have led her to pursue projects around the world, allowing her to draw connections between different geographic areas, medical specialties, and health challenges. While earning her bachelor’s degree in East Asian studies at Yale University, she learned Mandarin, taking a year off college to pursue intensive language study in China and Taiwan. She also completed a public health internship in China, which inspired her to earn her master’s in public health from Yale. “I really enjoyed working with colleagues in another country, learning from them and solving problems together,” she said.

She then spent time in sub-Saharan Africa, working as an operations assistant for the Community Health Worker program of the Earth Institute’s Millennium Villages project in Malawi. Dr. McLaughlin also served as a research assistant for Partners in Health in Lesotho, focusing on projects related to HIV and tuberculosis.

Her global health experience in both China and sub-Saharan Africa came together when she spent a year as a Fulbright scholar in Guangzhou, China, working with an infectious disease specialist. Dr. McLaughlin conducted interviews in English and Mandarin with African immigrants in Guangzhou about their experiences with the Chinese health care system.

Cardiology and HIV

After completing her medical degree from Harvard Medical School, Dr. McLaughlin chose UCSF for her internal medicine residency. After growing up near Los Angeles, she was excited to return to California. She was also attracted to UCSF as an institution. “I’d done a lot of work related to HIV, and UCSF played such a prominent role in the early AIDS epidemic, so I was interested in that history and expertise here at UCSF,” she said. “I was also drawn to our three-hospital system, including the San Francisco Veterans Affairs Medical Center (SFVAMC), Parnassus, and Zuckerberg San Francisco General Hospital (ZSFG).” 

As an intern, her first rotation was cardiology at ZSFG, and one of her first attendings was Priscilla Hsue, MD, who specializes in the cardiovascular health of people living with HIV. “In medical school, I’d become interested in cardiology, even though I had a long background in infectious disease and HIV in particular,” said Dr. McLaughlin. “Dr. Hsue’s work was at the intersection of two of my interests, and we started working together.”

Their first project together was studying persons with HIV whose disease was controlled with medication. “Although their viral load is suppressed, there are ways to measure how much virus is still circulating,” said Dr. McLaughlin. “We found that even in patients with well-controlled HIV, higher levels of circulating virus were independently associated with plaque in the carotid arteries.” They also found that among persons with HIV and intermediate to high risk of developing atherosclerotic cardiovascular disease, there were treatment gaps in the number of eligible patients who were prescribed a statin. 

Another project invited persons with HIV to give feedback on text messages designed to increase awareness of their elevated risk of developing cardiovascular disease, and concrete ways to decrease that risk through diet, exercise, smoking cessation, and other preventive approaches. “We did individual interviews with participants, had them rate how useful, understandable and impactful the messages were, and invited them to share open-ended feedback,” said Dr. McLaughlin. “I learned that we could have had even more input from patients earlier on in the process, which is something I try to incorporate in the research I do now. It’s so important to start with the end user and understand what will be most helpful for them.”

“One important aspect of doing quality interviews is establishing rapport with the interviewee and helping them feel understood, heard, and comfortable sharing,” said Dr. McLaughlin. “The most important thing is to design and ask questions in a way that gets patients talking. My most successful interviews are when I ask the patient a question, and they just talk and talk and end up answering all the follow-up questions I had on my list. If they haven’t touched on some of my other questions, I ask follow-up questions. Although we have a standardized interview guide, every interview is different, depending on the participant.”

Getting the Message

While a general cardiology fellow at UCSF, Dr. McLaughlin also worked with Sanket Dhruva, MD, MHS, a cardiologist at SFVAMC. They collaborated on a project to encourage veterans who had received a pacemaker or cardiac defibrillator but who had stopped sending in transmissions from the device to resume that practice. These remote transmissions can give the cardiology team information about abnormal heart rhythms or problems with their device. 

The team tested the effectiveness of sending a postcard reminder with either a positive message describing the benefits of remote monitoring, or a negative message outlining the dangers of not participating in remote monitoring. Dr. McLaughlin was particularly interested in the study’s “stepped-wedge” design, in which an intervention is rolled out to all participants, but in different waves or stages; the groups who receive the intervention later serve as controls to the earlier groups, allowing researchers to measure the effects of the intervention.

“We saw a large increase of people getting re-engaged with remote transmissions if they received a postcard,” said Dr. McLaughlin. “Interestingly, we didn’t see a big difference between the efficacy of positive or negative messages. It was fun to see that trial in practice, and how to roll it out in a stepwise fashion to study the postcards’ effect. What was really remarkable was that because we had these study outcomes, we could show how effective the intervention was. It ended up getting rolled out to the VA nationally, and was an example of a study that really made a difference in [clinical] practice.”

Advanced Training and Teamwork

In addition to gaining research experience during her fellowship, Dr. McLaughlin also enjoyed her clinical training. “I especially enjoyed working at San Francisco General, where fellows had a lot of autonomy because there is no interventional cardiology fellow there,” she said. “As a general cardiology fellow, we get called about STEMIs, and go in during the middle of the night to help the cath [cardiac catheterization] attending with those cases. That was a great learning experience.”

She also appreciated getting to read echocardiograms. “I really enjoy the combination of anatomy and physiology, and the way that the Echocardiography Lab intersects with all the other subspecialties within cardiology,” said Dr. McLaughlin. “All cardiologists order echoes on patients to help guide care, and people often come to the Echo Lab to discuss cases. We also have physicians from other specialties like Infectious Diseases come to review endocarditis cases.”

After finishing her general cardiology fellowship, Dr. McLaughlin then completed an advanced echocardiography fellowship. In addition to learning advanced skills in reading echocardiograms, she also received extensive training in performing transesophageal echocardiograms (TEEs), which obtain high-quality images of the heart by inserting a probe through a sedated patient’s mouth and into their esophagus.

This imaging modality is also critical for helping the interventional cardiology team on structural valve cases, in which a clip or replacement valve is threaded through a catheter up into the heart; the TEE provides visual guidance, serving as the “eyes” for the whole team. “It’s a lot of teamwork and collaboration between the structural and interventional cardiologists and the echocardiographer, and I learned so much from all of the faculty,” she said. 

Supporting Postpartum Heart Health

As a general cardiology fellow, Dr. McLaughlin also became interested in women’s cardiovascular health. She worked in UCSF’s Pregnancy and Cardiac Treatment (PACT) program, a multidisciplinary preconception and prenatal clinic for women with heart disease. The care team includes specialists in cardiology, maternal-fetal medicine, obstetric anesthesia, critical care, nursing and social work. 

A pregnant woman’s body adapts in astonishing ways to accommodate the increased workload of circulating blood through both her own body as well as the placenta. Total blood volume may increase by 30 to 50 percent, and the mother’s heart chambers may temporarily remodel or stretch to increase cardiac output. The placenta also releases a hormone called relaxin to lower systemic vascular resistance, making it easier for the mother’s heart to pump blood. After giving birth, the heart chamber sizes and systemic vascular resistance revert to normal, a process that may take weeks or months.

“I became interested in women who have adverse pregnancy outcomes during their pregnancies, such as preeclampsia or other kinds of hypertension during pregnancy, as well as gestational diabetes,” said Dr. McLaughlin. “People often talk about pregnancy as a ‘stress test’ or a window into future cardiovascular health, and I was curious about what happened to these patients after pregnancy, and what we can do to prevent them from developing cardiovascular disease in the decades to come. That postpartum period might be a particularly critical time for ensuring blood pressure control and management.”

Many of these patients fall through the cracks. After their six-week postpartum visit, many women’s obstetric care ends, and they are supposed to follow up with their primary care physician. However, some women don’t have a primary care physician, or their provider may not be as aware of the association between adverse pregnancy outcomes and long-term cardiovascular health.

To learn how to improve care for these patients, Dr. McLaughlin attended scientific sessions on women’s cardiovascular disease at national conferences of the American Heart Association (AHA) and the American College of Cardiology (ACC), and soon joined the ACC Prevention of Cardiovascular Disease Leadership Council. She conducted a national analysis of disparities in hypertension care for women, winning second prize in the AHA’s national Research Goes Red Data Challenge.

Dr. McLaughlin also joined the ACC Postpartum Hypertension Working Group and became a co-author of the ACC Postpartum Hypertension Clinic Development Toolkit. “We drew on experiences of programs around the country to put together this toolkit, which lowers the barriers to starting this kind of clinic,” said Dr. McLaughlin. “It includes resources such as clinical algorithms about how to treat blood pressure postpartum and downtitrate medications if blood pressure improves, and which medications are safe for breastfeeding. It also has example note templates [for the electronic health record] as well as information about billing, and how to make a clinic like this financially sustainable.”

Phoebe Ashley, MD, MS, Dr. McLaughlin, and specialists in Maternal-Fetal Medicine launched the UCSF Postpartum Cardiometabolic Wellness Clinic this year. “Currently it focuses on women who have had preeclampsia and other hypertensive pregnancy disorders, but eventually we hope to expand it to other adverse pregnancy outcomes,” she said. “It’s a critical time period, because in some cases patients’ blood pressure will return to normal, but others go on to have abnormal blood pressure for longer or develop chronic hypertension. We work collaboratively on blood pressure control, screen for other cardiovascular risk factors, and educate patients about their long-term cardiovascular risk. Depending on a patient’s course, the idea is to follow patients for up to one year postpartum. We also encourage patients to see their primary care doctor, or refer them if they don’t yet have one.”

“Dr. McLaughlin is a leader in her field as a cardiologist specializing in women’s heart health,” said Juan M. González Vélez, MD, PhD, Russell K. Laros, Jr., MD, Endowed Chair in Clinical Obstetrics and Gynecology and director of the Division of Maternal-Fetal Medicine and Reproductive Genetics. “She is a visionary in enhancing postpartum care and cardiovascular risk reduction for women who have experienced adverse pregnancy outcomes. Her research and clinic work are essential for raising awareness, providing targeted prevention and early detection, and offering tailored treatments that address the distinct cardiovascular challenges this population faces.”

Closing Gaps in Care

Dr. McLaughlin is also conducting research about gaps in postpartum care for women with hypertensive disorders during pregnancy. She analyzes national datasets and interviews patients to better understand the care they receive for blood pressure management after giving birth. One pilot project led by the Department of Obstetrics, Gynecology and Reproductive Sciences and the Office of Population Health distributed Bluetooth-enabled blood pressure cuffs to patients as part of their prenatal or postpartum care. Recipients also work with a patient navigator and clinical team on blood pressure control.

“Multiple participants described how much they appreciate these Bluetooth-enabled cuffs that automatically send blood pressure readings to their MyChart,” said Dr. McLaughlin. “A lot of these busy new parents’ focus is on their newborn, and it’s hard to make time for themselves and their own health. Being able to quickly measure their blood pressure and having that information go to their clinical team, without having to write it down, is really helpful. From interviewing patient navigators, we’ve also learned that oftentimes patients who are not engaging very well with the program have some kind of barrier or social determinant of health that impacts their ability to measure their blood pressure or take their medications. The navigators try to understand those barriers and help address them.”

As a relatively new mother herself, Dr. McLaughlin now has a deeper understanding of the challenges that parents of newborns face. “It’s one thing to understand theoretically that it will be all-consuming to care for a newborn and manage your own health conditions, but it’s another thing to actually do it yourself,” she said. “I can really empathize with my patients, and think my experience helps me conduct these interviews and better understand my patients’ perspectives.”

“I was thrilled when Dr. McLaughlin decided to join the UCSF faculty after fellowship,” said Alexis Beatty, MD, MAS, Dr. McLaughlin’s research mentor. “She is already establishing herself as a leader in improving women’s cardiovascular health and care delivery through clinical innovation and community-engaged research projects related to postpartum high blood pressure and cardiometabolic disease.”

In addition to conducting research and seeing patients in the Postpartum Cardiometabolic Wellness Clinic, Dr. McLaughlin also sees general cardiology patients in clinic, cares for hospitalized patients, and is an attending physician in the Echocardiography Lab. “I really like the longitudinal aspect of taking care of patients in clinic, getting to know them over time, and developing trust and long-term relationships,” she said.

Outside of medicine, Dr. McLaughlin enjoys tending her vegetable and herb garden, going on walks with her senior rescue dog, and spending time with her young son and her husband, a Stanford cardiologist. 

-  Elizabeth Chur