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Cardiovascular Risk Assessment as a Quality Measure in the Pregnancy and Postpartum Period
Afshan B Hameed1, Maryam Tarsa2, Cornelia R Graves3
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of California, Irvine, California, USA; Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, California, USA.
Insights
Implementing cardiovascular disease (CVD) risk assessment in clinical practice is feasible. This strategy may help reduce pregnancy-related deaths by detecting CVD early in pregnant and postpartum patients.
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.
Background:
Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for over one-third of all pregnancy-related deaths. Contributing factors such as lack of recognition and delayed diagnosis of CVD are primarily due to the overlap of signs and symptoms of a normal pregnancy with those of CVD.
Objectives:
This study aimed to demonstrate the feasibility of introducing CVD risk assessment into clinical practice using the California Maternal Quality Care Collaborative algorithm to detect CVD during pregnancy and postpartum periods.
Methods:
We implemented the CVD risk assessment algorithm into electronic health records at 3 large hospital networks serving over 14,000 patients at 23 sites. We determined the percentage of pregnant and/or postpartum patients who were screened for CVD risk and the follow-up rate for patients in whom the tool recommended a follow-up assessment. Rates were stratified according to clinical site characteristics. We obtained clinician feedback regarding the feasibility and acceptability of the tool.
Results:
The rate of patients screened for CVD risk in the 3 hospital networks was 57.1%, 71.5%, and 98.7%. For those with a positive screen, follow-up rates were 65.8%, 72.5%, and 55.9% in the 3 networks. The rates of screening and follow-up varied based on the clinic size and specialty. Clinician-identified barriers were busy clinics, competing priorities, and the type of clinical practice.
Conclusions:
This innovative population-based approach for universal CVD risk assessment during pregnancy is feasible and may be a helpful strategy to decrease CVD-related maternal morbidity and mortality.
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