Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive...

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease, highlighting the importance of thorough cardiovascular screening in individuals with prior HDP.

This retrospective cohort study evaluated rates of cardiovascular screening studies (lipid panel, lipoprotein(a), apolipoprotein B, hemoglobin A1c) ordered by cardiology in the first year postpartum before and after establishment of a postpartum cardiovascular care pathway within the Inova Health System.

The study population included postpartum adults with recent pregnancies complicated by HDP seen by designated clinicians after care pathway establishment (7/1/23-3/31/24) in the cardio-obstetrics cohort (n = 113) or by cardiology before care pathway establishment (6/1/20-6/30/23) in the historical cohort (n = 179). Sociodemographic and clinical characteristics and rates of screening ordered were evaluated between cohorts.

There were no significant differences between cohorts in age, race/ethnicity, parity, prior history of HDP, or rates of pre-eclampsia. The mean age across both cohorts was 33 years. The cardio-obstetrics cohort had significantly higher rates of screening ordered compared to the historical cohort: lipid panel: 85.0% vs 33.0%, lipoprotein(a): 62.8% vs 6.2%, apolipoprotein B: 31.0% vs 1.1%, and hemoglobin A1c: 76.1% vs 18.4% (all P < 0.001). Evaluation of prepregnancy and postpregnancy cardiometabolic health parameters and electronic medical record-based social determinants of health and psychological health screening demonstrated elevated rates of risk factors across both cohorts.

Implementation of a postpartum cardiovascular care pathway is feasible and is associated with significantly increased rates of cardiometabolic risk factor screening ordered in the first year postpartum.