California Cardiovascular Screening Tool: Findings from Initial Implementation.

Area of Science:

• Cardiovascular disease screening in obstetrics
• Maternal health and cardiovascular risk assessment
• Public health and epidemiological studies

Background:

• The American College of Obstetricians and Gynecologists (ACOG) introduced a cardiovascular disease (CVD) screening algorithm for pregnant and postpartum women.
• Existing data on the algorithm's performance in diverse obstetric populations is limited.
• Understanding screen-positive and true-positive rates is crucial for effective implementation.

Purpose of the Study:

• To prospectively evaluate the screen-positive and true-positive rates of the ACOG CVD screening algorithm in pregnant and postpartum women.
• To compare the algorithm's performance across two distinct populations in California (CA) and New York (NY).
• To identify key risk factors contributing to positive CVD screens.

Main Methods:

• A prospective cohort study involving 846 obstetrical patients from April 2018 to July 2019 at academic medical centers in CA and NY.
• Patients were screened for CVD risk factors, abnormal physical examinations, and persistent symptoms.
• Screen-positive individuals underwent further testing to determine true-positive CVD cases.

Main Results:

• The overall screen-positive rate was 8% (5% in CA vs. 19% in NY), with significant differences attributed to ethnicity and substance use.
• The true-positive rate for CVD was 1.5% at both sites.
• Combinations of moderate risk factors significantly influenced screen-positive rates; follow-up completion varied between sites.

Conclusions:

• This study provides the first prospective data on the CVD screening algorithm's performance in a general obstetric population.
• Demographic factors, such as the proportion of African American women, impact positive screening likelihood.
• The algorithm effectively identifies women at higher lifetime CVD risk, potentially enabling targeted postpartum interventions.