Results of Cardiovascular Testing among Pregnant and Postpartum Persons Undergoing Standardized Cardiovascular Risk Assessment.

Abstract

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(s): 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 < 0.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative (23.4% vs. 6.6%; p < 0.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (p < 0.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (p < 0.0001).

Conclusion(s): 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.