Implementation Of A Screening Guideline For An Multidisciplinary Clinic Care of Pregnant Women With Underlying Cardiac Disease In An Urban Academic Healthcare System

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Presentation: 46:29

Completed in partial fulfillment of the requirements for the degree PhD in Population Health Sciences.


Pregnancy-related maternal mortality is rising in the United States, with the most common underlying etiology now cardiac and hypertensive disease. Health care decisions in the diagnosis and treatment of cardiovascular disease have likewise been linked to maternal mortality. Implementation of a cardio-obstetrics program, including a guideline and multidisciplinary clinic, may standardize and optimize care.

Methods: This study used a combination of retrospective and prospective cohorts as well as cross-sectional surveys of providers and patients to assess the implementation of the cardio-obstetrics program at Thomas Jefferson University. Prevalence of resting heart rates recorded for return prenatal care visits pre- and post-implementation of a guideline in January 2020 were compared. Staff perspective regarding implementation of the cardio-obstetrics program was solicited with a survey grounded in the Consolidated Framework for Implementation Research (CFIR) model. Patient experience with the multidisciplinary clinic started in March 2021 (consultations with both cardiology and maternal-fetal medicine (MFM) simultaneously) was captured using validated and published surveys, including the Patient Feedback on Consultation Skills (PFC) questionnaire. Utilization of transthoracic echo to screen for underlying heart disease in asymptomatic women at high risk for cardiac disease was assessed pre- and post-guideline implementation. Prevalence of clinically significant pathology was noted was well as cardiac and obstetric outcomes.

Results: Prior to implementation of the guideline, 257 out of 1200 (21.4%) return prenatal visits had a resting heart rate routinely obtained during prenatal care. This was significantly different after implementation of the guideline (1541 out of 2278, 67.6%, p

Conclusion: This study shows significant improvements in prevalence of heart rate screening and completion of transthoracic echocardiography after implementation of a cardio-obstetrics program. Staff and patients had overall positive experiences with implementation of this program. Additional adequately-powered prospective studies are needed to confirm improved patient outcomes.



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