OUTCOMES IN A HIGH-RISK PREGNANCY IN A PREDOMINANTLY MEDICAID INSURED POPULATION WITH CVD IN AN INNER-CITY HOSPITAL MANAGED WITH A CARDIO-OBSTETRICS PROGRAM

Abstract

Therapeutic Area: ASCD/CVD in Women Background: Maternal mortality in the United States has been increasing, and cardiovascular disease (CVD) is a leading factor for poor outcomes. We sought to investigate the characteristics of the patient population referred to a Cardio-Obstetrics program. Methods: Retrospective chart review of patients seen in a Cardio-Obstetrics Program from November 2019-January 2024. Demographics, comorbidities, and maternal and fetal outcomes were recorded. This is an integrated multidisciplinary group of maternal fetal medicine, genetics, anesthesia, general cardiology, advanced heart failure and pulmonary hypertension specialists. Results: During the study period, 114 pregnant patients were referred to the Cardio-Obstetrics Program with CVD. The mean age was 31±7 years old and body mass index was 33 ± 9.8 kg/m2. Regarding race/ethnicity, 41 (36%) identified as Latinx, 47 (41.2%) Black, and 21 (18.4%) White. 58 (50.9%) were insured with Medicaid. The four most common CV diagnoses leading to referral were HFrEF 22 (19%), congenital heart disease12 (10.5%), pulmonary hypertension 13 (11.4%) and supraventricular tachycardia 11 (9.6%). The median time from referral to appointment date was 12 days. During pregnancy 24 (21.1%) had chronic hypertensive disorder, 34(29.8%) pre-eclampsia, 2 (1.8%) eclampsia, and 15 (13.2% had gestational diabetes. We completed echocardiograms in 104 (91.2%) of the patients, RHC in 9 (7.9%), LHC in 4 (3.5%) and cardiac event monitor in 17 (14.9%). Brain natriuretic peptides were checked only on 21 patients. In their first trimester, the median brain natriuretic peptide was 15 (IQR 2.5-44.9), second trimester was 41.5 (IQR 3-399), third trimester 23 (IQR 4-136), and post-delivery 60 (IQR 2.5-1622). Vaginal delivery occurred in 67 (58%) of the cases and termination in 4 (3.5%). The main complications observed were 1 (0.8%) cardiac arrest, 40 (35%) pre-term labor and 4(3.5%) stillborn. There were no maternal deaths during the study period. Conclusions: We found in a population of primarily Medicaid-insured pregnant people managed by a cardio-obstetrics team, maternal outcomes are encouraging. Use of expedited access to care can lead to favorable outcomes.