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Published on: May 27, 2022
Referral to Cardiology Following Postpartum Cardiovascular Risk Screening at the Maternal Health Clinic in Kingston,
Rachel A Gladstone1, Jessica Pudwell1, Raveen S Pal2
1Department of Obstetrics and Gynaecology, Kingston Heath Sciences Centre, Queen's University, Kingston, Ontario, Canada.
Insights
Postpartum screening identifies high cardiovascular disease (CVD) risk in women, but follow-up care is lacking. Many referred women miss appointments, delaying crucial interventions for CVD prevention.
Area of Science:
- Cardiology
- Obstetrics
- Public Health
Background:
- Cardiovascular disease (CVD) is the leading cause of death in women globally.
- Pregnancy complications can indicate future CVD risk.
- Current postpartum screening lacks recommended follow-up for identified cardiovascular risk factors.
Purpose of the Study:
- To describe referral practices and clinical course for postpartum women at high cardiovascular risk.
- To examine timing and interventions for reducing CVD risk in this population.
Main Methods:
- Investigated a cohort of women referred from a postpartum Maternal Health Clinic to cardiology.
- Examined referral patterns, appointment scheduling, and clinical outcomes.
Main Results:
- Referred women had a history of hypertensive disorders of pregnancy and worse CVD risk profiles.
- Referred women had a 5-year shorter life expectancy.
- Only 50% scheduled cardiology appointments, with a median delay of 12 months; 60% were eligible for cardiac rehabilitation.
Conclusions:
- Current systems are inadequate for managing high-risk postpartum women.
- Delayed or missed appointments hinder timely interventions.
- CVD prevention programs should commence within one year postpartum.
Background:
Cardiovascular disease (CVD) is the leading cause of death globally among women, and certain pregnancy complications can be the earliest indicators of increased CVD risk. Nonetheless, there is no recommendation for follow-up of cardiovascular risk factors identified through postpartum screening programs. This study describes current referral practices and clinical course from the Maternal Health Clinic in Kingston, Ontario, for women deemed at high cardiovascular risk postpartum.
Methods:
We investigated the cohort of women referred from the postpartum Maternal Health Clinic to cardiology for further assessment and management, specifically examining timing and recommended interventions to reduce CVD risk.
Results:
Women referred to cardiology differed significantly from those not referred in history of hypertensive disorders of pregnancy (P < 0.05) and demonstrated a significantly worse CVD risk profile at 6 months postpartum (P < 0.0001). Life expectancy by the cardiometabolic model for women referred was 5 years shorter (P < 0.0001). Only half of the women referred to cardiology scheduled a visit; the median time to the scheduled appointment was 12 months. Of women seen by cardiology, 60% were deemed eligible for cardiac rehabilitation.
Conclusions:
Although women at highest risk for CVD are being identified and referred to cardiology, the existing system is not designed for this demographic. Too many women are missing their appointments or being seen beyond 1 year postpartum. To initiate lifestyle changes and/or therapeutic interventions, we suggest that CVD prevention programming begins within 1 year of delivery. Future studies should investigate the viability of traditional cardiac rehabilitation programs among this unique population.
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