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Results of cardiovascular testing among pregnant and postpartum persons undergoing standardized cardiovascular risk
Afshan B Hameed1, Maryam Tarsa2, Ashten Waks3
1Division of Maternal-Fetal Medicine, Department Obstetrics & Gynecology, School of Medicine, University of California, Irvine, CA (Hameed, Waks, Balogun, and Thiel de Bocanegra); Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, CA (Hameed).
Insights
A standardized cardiovascular disease (CVD) risk assessment identified more pregnant patients with abnormal test results than clinician judgment alone. This tool aids in detecting unknown or developing CVD for improved maternal health outcomes.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) is the leading cause of maternal mortality in the US.
- A standardized CVD risk assessment can identify at-risk patients during pregnancy.
Purpose of the Study:
- To compare the effectiveness of a standardized CVD risk assessment versus clinician judgment alone in identifying abnormal CVD findings in pregnant and postpartum patients.
Main Methods:
- Retrospective chart review of 31,232 pregnant/postpartum patients across three hospital networks.
- Comparison of abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results between standardized assessment and clinician judgment groups.
- Statistical analysis using two Proportion Z-Test and odds ratios.
Main Results:
- Standardized assessment identified more abnormal tests (6.9%) than clinician judgment (4.2%; p<.0001).
- Risk-positive patients had significantly higher odds of abnormal tests (4.31 times) compared to risk-negative patients (p<.0001).
- Patients assessed via standardized tool had 1.69 times the odds of abnormal tests than those assessed by clinician judgment alone (P<.0001).
Conclusions:
- Standardized CVD risk assessment enhances detection of previously unknown or developing CVD in pregnant/postpartum patients.
- This algorithm serves as a valuable adjunct to clinician judgment for improved perinatal outcomes.
- Early identification and management of CVD risk in pregnancy are crucial for reducing maternal mortality.
Background:
Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for one in three pregnancy-related deaths. A standardized CVD Risk Assessment can guide clinicians in identifying patients at risk for CVD.
Objective:
The objective of this study was to evaluate whether a standardized CVD risk assessment yields more abnormal findings on follow-up CVD testing among pregnant and postpartum patients compared to assessments based on clinician judgment alone.
Study Design:
A retrospective chart review was performed across three geographically and ethnically diverse hospital networks that had implemented the CVD Risk Assessment algorithm. The analysis included a total of 31,232 pregnant and postpartum patients who had presented for obstetric care visit from September 2020 to August 2024. We calculated the proportion of patients with abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results by risk assessment group, and a two Proportion Z-Test was conducted to compare proportions. We then calculated the odds of having abnormal tests for each risk assessment group.
Results:
Standardized CVD risk assessment yielded more abnormal composite test results than clinician judgment alone (6.9% vs. 4.2%; p<.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative group (23.4% vs. 6.6%; P<.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (P<.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (P<.0001).
Conclusion:
Implementing a standardized CVD Risk Assessment algorithm may enhance the detection of cardiovascular disease in pregnant and postpartum patients with previously unknown CVD or at risk of developing CVD, providing a valuable tool that complements clinician judgment for improved perinatal outcomes.
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