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Alliance for Innovation on Maternal Health: Consensus Bundle on Cardiac Conditions in Obstetric Care
Afshan B Hameed1, Alison Haddock, Diana S Wolfe
1Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, and the Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California; the Departments of Emergency Medicine and Education, Innovation and Technology, Baylor College of Medicine, Houston, Texas; the Department of Obstetrics & Gynecology and Women's Health and the Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York; the Department of Obstetrics & Gynecology, University of Missouri-Kansas City, Saint Luke's Hospital, Kansas City, Missouri; the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan; the American College of Obstetricians and Gynecologists, Washington, DC; and the National Association of Nurse Practitioners in Women's Health, Washington, DC.
Insights
Cardiac conditions are a leading cause of preventable pregnancy-related deaths, especially for non-Hispanic Black individuals. This guidance promotes multidisciplinary care for pregnant and postpartum patients with heart conditions.
Area of Science:
- Cardiology
- Obstetrics
- Public Health
- Health Equity
Background:
- Cardiac conditions are the primary cause of pregnancy-related mortality, disproportionately impacting non-Hispanic Black individuals.
- Many deaths result from undiagnosed cardiovascular disease and are preventable, with obstetric complications increasing future cardiovascular risk.
- Specialized care is crucial for pregnant individuals with cardiac risk factors or existing heart disease.
Purpose of the Study:
- To provide guidance for developing coordinated, multidisciplinary care for pregnant and postpartum individuals with cardiac conditions.
- To outline strategies for responding to cardio-obstetric emergencies.
- To integrate respectful, equitable care and health equity considerations into all domains of cardio-obstetric care.
Main Methods:
- Development of the Cardiac Conditions in Obstetric Care patient safety bundle by the Alliance for Innovation on Maternal Health.
- Organization of the bundle into five domains: Readiness, Recognition and Prevention, Response, Reporting and Systems Learning, and Respectful Care.
- Integration of health equity considerations across all bundle domains.
Main Results:
- The bundle offers condition-specific clinical practices for healthcare teams.
- It emphasizes a multidisciplinary approach to patient care and emergency response.
- It introduces 'Respectful Care' as a core domain, promoting equitable and supportive patient experiences.
Conclusions:
- Implementing this bundle can improve care coordination and reduce preventable morbidity and mortality in pregnant and postpartum individuals with cardiac conditions.
- The inclusion of Respectful Care and health equity considerations addresses critical disparities in maternal cardiac care.
- This initiative supports the Alliance for Innovation on Maternal Health's goal of enhancing patient safety in obstetric care.
Abstract:
Cardiac conditions are the leading cause of pregnancy-related deaths and disproportionately affect non-Hispanic Black people. Multidisciplinary maternal mortality review committees have found that most people who died from cardiac conditions during pregnancy or postpartum were not diagnosed with a cardiovascular disease before death and that more than 80% of all pregnancy-related deaths, regardless of cause, were preventable. In addition, other obstetric complications, such as preeclampsia and gestational diabetes, are associated with future cardiovascular disease risk. Those with cardiac risk factors and those with congenital and acquired heart disease require specialized care during pregnancy and postpartum to minimize risk of preventable morbidity and mortality. This bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people with cardiac conditions and to respond to cardio-obstetric emergencies. This bundle is one of several core patient safety bundles developed by the Alliance for Innovation on Maternal Health that provide condition- or event-specific clinical practices for implementation in appropriate care settings. The Cardiac Conditions in Obstetric Care bundle is organized into five domains: 1) Readiness , 2) Recognition and Prevention , 3) Response , 4) Reporting and Systems Learning , and 5) Respectful Care . This bundle is the first by the Alliance to be developed with the fifth domain of Respectful Care . The Respectful Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into elements in each domain.
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