Collaborative Care Approach Could Improve Care for Pregnant Women with CVD

This article originally appeared on Endocrinology Network’s sister site, PracticalCardiology.com.

Jennifer Haythe, MD

A new study from Columbia University Irving Medical Center is providing additional evidence to the positive impact of implementing a cardio-obstetrics team when caring for pregnant women with cardiovascular disease.

A review of data from more than 300 pregnant women, results of the study give further credence to the notion that implementation of such a practice would lead to improvements in care and outcomes for pregnant women with cardiovascular disease.

"While cardiologists have been managing the care of pregnant women for decades, the notion of a dedicated cardio-obstetrics team is a recent development aimed at reducing maternal death rates due to cardiovascular disease," said lead investigator Jennifer Haythe, MD, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, in a statement. "This study shows that programs like ours may help provide improved cardiovascular care to an otherwise underserved population, though more research is needed to evaluate the impact of these programs."

With a recent emphasis on encouraging the use of cardio-obstetric teams for expecting mothers, Haythe and a team of colleagues sought to describe the clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions from a cohort of pregnant women with cardiovascular disease being treated with su h an approach. To do so, they designed their study as an analysis of women treated by the cardio-obstetrics team at Columbia University Irving Medical Center between January 1, 2010-December 31, 2019.

From electronic medical record data, investigators obtained information related to demographics, comorbidities, underlying cardiovascular disease, medications, outcomes, and cardiovascular readmissions of patients treated by the team during the aforementioned time period. Based on this information, all patients considered eligible for inclusion were assigned a Cardiac Disease in Pregnancy (CARPREG) II score.

In total, 306 pregnant women with cardiovascular disease were identified over the study period. The median age at delivery was 30 (IQR, 25-35) years, 52.9% were Hispanic or Latino, and 74.2% were insured through Medicaid. The median CARPREG II score was 3, with 42.5% of patients receiving a score of 4 or greater. Among the entire study cohort, the most common forms of cardiovascular disease were arrhythmias (28.8%), congenital heart disease (23.5%), cardiomyopathy (23.5%), and valvular heart disease (16.3%).

When assessing maternal outcomes, investigators found 11.4% of patients developed gestational diabetes, 9.5% had gestational hypertension, and preeclampsia was present in 12.1% of patients. Investigators also pointed out 3.6% of patients required treatment with insulin and 1.6% required medication for treatment of gestational hypertension.

Results indicated patients treated by the cardio-obstetrics team had 30-day readmission rate of 2% and a readmission rate of 4.6% for the period 30-90 days after delivery. Investigators noted a single maternal death occurred within a year of delivery in a woman with Eisenmenger syndrome.

In the aforementioned statement, Haythe points out the low rate of readmissions underlines the real-world impact of collaborative care with a cardio-obstetrics team.

"Despite the high cardiovascular risk in our study population, we found low rates of maternal and fetal complications and a low rate of hospital readmissions after delivery compared to previously published national rates," Haythe added.

This study, “Cardiovascular Care for Pregnant Women With Cardiovascular Disease,” was published in the Journal of the American College of Cardiology.