June 14, 2022
Orange, Calif. — UCI Health maternal-fetal expert Dr. Afshan Hameed is spearheading a national study of a promising risk-assessment tool to predict cardiovascular disease during pregnancy, which is the leading cause of maternal mortality in the United States.
With funding from the Diagnostic Excellence Initiative of the Gordon and Betty Moore Foundation and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Hameed is partnering with major national healthcare systems to implement and evaluate an algorithm she helped develop to screen pregnant and postpartum patients for cardiovascular disease.
Early identification of a patient’s CVD risk will lead to better monitoring and early intervention to prevent pregnancy complications and death.
“The aim of the study is to validate the potential of this tool to become the CVD national screening standard for pregnant patients,” said Hameed, a professor of obstetrics and gynecology, maternal-fetal medicine and cardiology at the UCI School of Medicine.
Addressing the main cause of maternal death
“This will not only further our knowledge about the overall CVD disease process in pregnant patients, but it also will afford us an opportunity to address the main cause of maternal mortality and improve health outcomes in patients with chronic medical conditions and CVD risk factors,” she added.
Hameed’s partners include UC San Diego Health, Ascension Saint Thomas Hospital and the University of Tennessee in Nashville, University of Missouri-Kansas City Health Sciences, and New York City’s Albert Einstein College of Medicine and Montefiore Health System.
CVD accounts for more than a third of all US pregnancy-related deaths. This is because CVD symptoms in pregnant patients are often misdiagnosed or dismissed, leading to delays in recognizing and treating conditions that may lead to serious short- and long-term morbidity and mortality.
The problem is especially acute for Black patients, whose rate of maternal mortality is three times higher than for whites. They also have substantially higher rates of pre-existing heart disease, hypertensive disorders of pregnancy and peripartum cardiomyopathy than other racial and ethnic groups.
In addition, caring for patients with undetected CVD during pregnancy and postpartum is expensive. The annual median cost for heart failure care alone in the general US population is estimated at $24,383 per patient, with hospitalization being the primary cost driver, according to a 2020 study.
Identifying who is at risk
While there is currently no standardized screening tool to help clinicians identify pregnant patients at risk of CVD who may benefit from further testing and care, Hameed previously led a working group of the California Maternal Quality Care Collaborative (CMQCC) to develop an algorithm that stratifies pregnant and postpartum patients by those at low and high risk for CVD.
The resulting 18-item screening assessment, which can be integrated with a patient’s electronic health record, can flag those at risk for CVD and recommend a cardiology consultation and further testing. It was endorsed by the American College of Obstetricians and Gynecologists (ACOG) and it is included in the Alliance for Innovation for Maternal Health’s information on CVD and obstetrical care. But a larger national study is needed to fully evaluate the algorithm’s predictive value as a CVD screening tool.
The prestigious NICHD grant provides more than $450,000 over two years for the new national study. R21 grants are designed to fund exploratory research that has significant potential to lead to advances in health research. The research also is supported by more than $800,000 in funding from the Moore Foundation.
For its initial algorithm testing, UCI Health screened more than 1,400 pregnant patients, of whom 35 (about 2.5%) were found to be at risk for CVD. A smaller sample of 26 at-risk patients received additional heart tests. Of this group, 16 (61%) had a cardiovascular problem of concern. Ten of these patients had abnormalities that posed a significant risk to their health and that of their baby, including heart failure and enlargement of the left atrial chamber.
The first aim of the new study is to validate the CVD risk-assessment tool in about 3,000 pregnant and postpartum patients. Researchers will retrospectively review medical charts to describe the screening algorithm’s implementation across 23 clinical locations, and will gather feedback from clinicians and patients.
With this data, researchers next will determine the prevalence of CVD in pregnant and postpartum patients by race and ethnicity, comparing its frequency among African-American patients with those who are white, Latino, Asian or of other of races or ethnicities.
Finally, researchers will calculate the predictive value of each of the CVD screening algorithm’s items, assessing their true and false positive values.
“Improved diagnostic excellence and the management of at-risk patients are vital in averting CVD,” Hameed said. “The development and validation of a standardized screening promises a way for clinicians to identify and provide early treatment for patients with CVD, thus reducing morbidity, mortality and the healthcare cost burden.”
Learn more about the CVD screening algorithm and toolkit ›
About Afshan Hameed, MD
A fellowship-trained cardiologist and maternal-fetal specialist, Hameed is focused on maternal cardiovascular disease, anticoagulation in pregnancy, valvular disease and the prevention of maternal morbidity and mortality. She is the director of Patient Safety and Quality for UCI Health maternity services.
Hameed helped develop cardiovascular and venous thromboembolism toolkits published by the California maternal care collaborative and served on the ACOG Presidential Task Force for the publication of its 2019 Practice Bulletin on heart disease in pregnancy.
She also served as an expert to help develop a curriculum for basic obstetrics life support to integrate with the American Heart Association Life Support Program and was a member of the Society of Maternal-Fetal Medicine’s Quality and Patient Safety Committee.
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