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Guerrero KM, Wolfe DS, Hameed AB, Thiel De Bocanegra H. Patient Experiences and Behavioral Changes Following Cardiovascular Risk Assessment During Pregnancy and Postpartum. J Patient Exp 2025; 12:23743735251325130. [PMID: 40290732 PMCID: PMC12033443 DOI: 10.1177/23743735251325130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States. Two major hospital networks implemented a novel CVD risk assessment of pregnant and postpartum patients to standardize identification of patients with previously unknown CVD or at risk to develop CVD. This qualitative study explored the experience of being identified as at CVD risk in a purposive sample of 10 obstetric patients. Participants varied by age, race/ethnicity, language (English/Spanish), and comorbidities. Interviews focused on patients' awareness, emotional responses, clinician-patient communication, and behavioral intentions. Thematic analysis using Atlas.ti 8 revealed a limited understanding of the association between CVD and pregnancy complications and lifetime CVD risk. Positive risk assessments triggered surprise and concern. Overall, patients evaluated the clinician-patient communication positively but found information too cursory and varied in strategies to find out more details. Several patients initiated immediate lifestyle changes, while others waited for guidance from clinicians. The study underscores the need to engage patients in the implementation of screening tests and to improve health literacy to facilitate follow up care and behavior change.
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Affiliation(s)
- Kerly M. Guerrero
- Obstetrics, Gynecology and Women's Health, Division of Maternal Fetal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Diana S. Wolfe
- Obstetrics, Gynecology and Women's Health, Division of Maternal Fetal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshan B. Hameed
- Obstetrics and Gynecology, Maternal Fetal Medicine, University of California, Irvine, CA, USA
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Krokhaleva Y, Vaseghi M. Editorial commentary: The birth and growth of Cardio-Obstetrics: Managing cardiovascular risk and disease in pregnancy. Trends Cardiovasc Med 2025; 35:175-176. [PMID: 39608589 PMCID: PMC11968207 DOI: 10.1016/j.tcm.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 11/15/2024] [Indexed: 11/30/2024]
Affiliation(s)
- Yuliya Krokhaleva
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Marmar Vaseghi
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA.
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Briller J, Trost SL, Busacker A, Joseph NT, Davis NL, Petersen EE, Goodman DA, Hollier LM. Pregnancy-Related Mortality Due to Cardiovascular Conditions: Maternal Mortality Review Committees in 32 U.S. States, 2017 to 2019. JACC. ADVANCES 2024; 3:101382. [PMID: 39583867 PMCID: PMC11585746 DOI: 10.1016/j.jacadv.2024.101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/13/2024] [Accepted: 09/23/2024] [Indexed: 11/26/2024]
Abstract
Background Cardiomyopathy (CM) and other cardiovascular conditions (OCVs) are among the most frequent causes of pregnancy-related death in the United States. Objectives The purpose of this paper was to report demographic and clinical characteristics, preventability, contributing factors, and Maternal Mortality Review Committee (MMRC) recommendations among pregnancy-related deaths with underlying causes of CM, OCVs, and the 2 combined (cardiovascular conditions, CV). Methods We analyzed pregnancy-related death data from MMRCs in 32 states, occurring during 2017 to 2019, with MMRC-determined underlying causes of CVs. We describe distributions of demographic characteristics, present the most frequent contributing factor classes, and provide example MMRC prevention recommendations. Results Among 210 pregnancy-related deaths due to CVs, 84 (40%) were due to CM and 126 (60%) to OCVs. More than half (51.2%) of CM deaths were among non-Hispanic Black persons. Two-thirds (66%) of all CV deaths occurred among people <35 years old. Approximately 53% of CM deaths and 31% of OCV deaths occurred 43 to 365 days postpartum. Over 75% of pregnancy-related deaths due to CVs were determined by MMRCs to be preventable. The 5 most frequent contributing factor classes accounted for 50% of the total MMRC-identified contributing factors. MMRC prevention recommendations occur at multiple levels. Conclusions Most pregnancy-related deaths due to CM and OCV are preventable. Example MMRC recommendations provided in this report illustrate prevention opportunities that address contributing factors, including broader awareness of urgent warning signs, improved handoffs for care coordination and continuity, and expanded accessibility of community-based comprehensive and integrated care services.
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Affiliation(s)
- Joan Briller
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Susanna L. Trost
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Busacker
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naima T. Joseph
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nicole L. Davis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily E. Petersen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA
| | - David A. Goodman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa M. Hollier
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hameed AB, Tarsa M, Graves CR, Grodzinsky A, Thiel De Bocanegra H, Wolfe DS. Universal Cardiovascular Disease Risk Assessment in Pregnancy: Call to Action JACC: Advances Expert Panel. JACC. ADVANCES 2024; 3:101055. [PMID: 39372368 PMCID: PMC11450966 DOI: 10.1016/j.jacadv.2024.101055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 10/08/2024]
Abstract
The United States has the highest maternal mortality rate among developed countries, with cardiovascular disease (CVD) being one of the leading causes of maternal deaths. Diagnosing CVD during pregnancy may be challenging as symptoms of normal pregnancy overlap with those of CVD. Delays in recognition and response to the diagnosis of CVD is a missed opportunity for timely intervention to improve maternal outcomes. Implementing universal CVD risk assessment for all pregnant and postpartum patients across clinical care settings presents a pivotal opportunity to address this issue. Integrating a validated risk assessment tool into routine obstetric care, clinicians, including obstetricians, primary care, and emergency healthcare providers, can enhance awareness of cardiovascular risk and facilitate early CVD diagnosis. Consensus among stakeholders underscores the importance of screening and education on cardiovascular health strategies for pregnant and postpartum patients to reduce CVD-related maternal mortality. This comprehensive approach offers a pathway to identify at-risk individuals and intervene promptly, potentially saving lives and advancing maternal healthcare equity.
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Affiliation(s)
- Afshan B. Hameed
- Maternal-Fetal Medicine, Obstetrics & Gynecology, Cardiology, University of California, Irvine, California, USA
| | - Maryam Tarsa
- Division of Maternal-Fetal Medicine, University of California, San Diego, California, USA
| | - Cornelia R. Graves
- Division of Maternal-Fetal Medicine, University of Tennessee, Nashville, Tennessee, USA
| | - Anna Grodzinsky
- Cardiology, Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Heike Thiel De Bocanegra
- Maternal-Fetal Medicine, Obstetrics & Gynecology, Cardiology, University of California, Irvine, California, USA
| | - Diana S. Wolfe
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Adedinsewo D, Morales-Lara AC, Hardway H, Johnson P, Young KA, Garzon-Siatoya WT, Butler Tobah YS, Rose CH, Burnette D, Seccombe K, Fussell M, Phillips S, Lopez-Jimenez F, Attia ZI, Friedman PA, Carter RE, Noseworthy PA. Artificial intelligence-based screening for cardiomyopathy in an obstetric population: A pilot study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:132-140. [PMID: 38989045 PMCID: PMC11232425 DOI: 10.1016/j.cvdhj.2024.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Cardiomyopathy is a leading cause of pregnancy-related mortality and the number one cause of death in the late postpartum period. Delay in diagnosis is associated with severe adverse outcomes. Objective To evaluate the performance of an artificial intelligence-enhanced electrocardiogram (AI-ECG) and AI-enabled digital stethoscope to detect left ventricular systolic dysfunction in an obstetric population. Methods We conducted a single-arm prospective study of pregnant and postpartum women enrolled at 3 sites between October 28, 2021, and October 27, 2022. Study participants completed a standard 12-lead ECG, digital stethoscope ECG and phonocardiogram recordings, and a transthoracic echocardiogram within 24 hours. Diagnostic performance was evaluated using the area under the curve (AUC). Results One hundred women were included in the final analysis. The median age was 31 years (Q1: 27, Q3: 34). Thirty-eight percent identified as non-Hispanic White, 32% as non-Hispanic Black, and 21% as Hispanic. Five percent and 6% had left ventricular ejection fraction (LVEF) <45% and <50%, respectively. The AI-ECG model had near-perfect classification performance (AUC: 1.0, 100% sensitivity; 99%-100% specificity) for detection of cardiomyopathy at both LVEF categories. The AI-enabled digital stethoscope had an AUC of 0.98 (95% CI: 0.95, 1.00) and 0.97 (95% CI: 0.93, 1.00), for detection of LVEF <45% and <50%, respectively, with 100% sensitivity and 90% specificity. Conclusion We demonstrate an AI-ECG and AI-enabled digital stethoscope were effective for detecting cardiac dysfunction in an obstetric population. Larger studies, including an evaluation of the impact of screening on clinical outcomes, are essential next steps.
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Affiliation(s)
| | | | - Heather Hardway
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Patrick Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Carl H Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - David Burnette
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Mia Fussell
- Agape Community Health Center, Jacksonville, Florida
| | - Sabrina Phillips
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Sarma AA, Lau ES, Sharma G, King LP, Economy KE, Wood R, Wood MJ, Feinberg L, Isselbacher EM, Hameed AB, DeFaria Yeh D, Scott NS. Maternal Cardiovascular Health Post-Dobbs. NEJM EVIDENCE 2024; 3:EVIDra2300273. [PMID: 38320493 DOI: 10.1056/evidra2300273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Maternal Cardiovascular Health Post-DobbsPregnancy is associated with increasing morbidity and mortality in the United States. In the post-Dobbs era, many pregnant patients at highest risk no longer have access to abortion, which has been a crucial component of standard medical care.
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Affiliation(s)
- Amy A Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA
| | - Louise P King
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Rachel Wood
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Loryn Feinberg
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston
| | | | | | | | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Boston
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Misra A, Porras MP, Rajendran A, Contreras J, Scott NS. Cardio-Obstetrics: A Focused Review. Curr Cardiol Rep 2023; 25:1065-1073. [PMID: 37540401 DOI: 10.1007/s11886-023-01928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. RECENT FINDINGS Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Aardra Rajendran
- Department of Internal Medicine, John Hopkins University, Baltimore, MD, USA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and Transplant, Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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Scott NS, Sarma AA, Choi E. Bridging the Gap in Maternal Cardiovascular Risk: Identifying Patients at Elevated Risk. JACC. ADVANCES 2023; 2:100177. [PMID: 38939031 PMCID: PMC11198727 DOI: 10.1016/j.jacadv.2022.100177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Nandita S. Scott
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amy A. Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eunjung Choi
- Division of Cardiology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
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