1 hospital’s strategy to cut CVD deaths in pregnancy, postpartum

Cardiovascular disease is the leading cause of death during pregnancy and postpartum in the U.S., according to Andreea Creanga, MD, PhD, in a 2017 article in Obstetrics & Gynecology. To reduce mortality and improve cardiovascular health, some hospitals are changing the way they handle follow-up care.

“We’re noticing that many of these deaths happen after delivery, and they are preventable with better screening and follow-up,” Suzette Graham-Hill, MD, lead of the cardio-obstetric program at New York City-based NYC Health + Hospitals/Kings County, told Becker’s in an upcoming podcast episode. “Most of the deaths are related to cardiomyopathy and hypertensive disorders.”

Most of these deaths occur within one year postpartum, with Black women being disproportionately affected. Cardiovascular disease accounts for 26.5% of pregnancy-related deaths, the American Health Association found. 

“Hospital leaders are taking notice of these causes of morbidity and mortality because many of these outcomes are preventable with earlier screening, better follow-up and stronger coordination between obstetrics and cardiology,” Dr. Graham-Hill said. “Leaders have recognized that this is no longer just a clinical issue — it’s a systems and quality issue that requires collaboration to address.”

NYC Health + Hospitals/Kings County is addressing this need by forming cardio-obstetric teams that work alongside maternal health teams. Together, they implemented blood pressure monitoring, automated cardiology referrals for women with preeclampsia, standardizing follow up care and extended postpartum care.

“Operationally, this shifts maternal care from a short-term event to a long-term population health strategy,” Dr. Graham-Hill said. “Leaders at our hospital view maternal cardiovascular health as part of a quality improvement and risk management effort to better care for our patients.”

These early-detection and monitoring programs, along with states that expand Medicaid coverage to 12 months postpartum to improve follow-up access, have shown significant cuts in preventable deaths, she said. 

“The greatest opportunity lies in coordinated, patient-centered systems rather than isolated interventions,” she said.