Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy
Background: 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. Objectives: This retrospective cohort study evaluated rates of cardiovascular screeni...
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| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
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| Series: | JACC: Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25005137 |
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| Summary: | Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. |
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| ISSN: | 2772-963X |