Cardiovascular Risk Assessment as a Quality Measure in the Pregnancy and Postpartum Period.

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Public Health

Background:

• Cardiovascular disease (CVD) is the leading cause of maternal mortality in the U.S., responsible for over one-third of pregnancy-related deaths.
• Overlapping symptoms between normal pregnancy and CVD often lead to delayed diagnosis and underrecognition.

Purpose of the Study:

• To assess the feasibility of integrating CVD risk assessment into routine clinical practice.
• To utilize the California Maternal Quality Care Collaborative algorithm for detecting CVD in pregnant and postpartum individuals.

Main Methods:

• Implementation of the CVD risk assessment algorithm in electronic health records across 3 large hospital networks (23 sites, >14,000 patients).
• Determination of patient screening rates and follow-up rates for positive screens.
• Stratification of rates by clinical site characteristics and collection of clinician feedback on tool acceptability and feasibility.

Main Results:

• Patient screening rates for CVD risk were 57.1%, 71.5%, and 98.7% across the three networks.
• Follow-up rates for patients with positive screens ranged from 55.9% to 72.5%.
• Screening and follow-up rates varied by clinic size and specialty; clinician-reported barriers included busy clinics and competing priorities.

Conclusions:

• A population-based approach for universal CVD risk assessment during pregnancy is feasible.
• This strategy shows potential for decreasing CVD-related maternal morbidity and mortality.