570: Cardiac disease in pregnancy: do standardized protocols and risk stratification improve outcomes?

Abstract

To establish a prospective standardized protocol for the clinical evaluation of pregnant women with cardiovascular disease (CVD), create a standardized risk assessment tool and assess outcomes of women undergoing the standardized protocol compared with women who did not. The Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) initiative prospectively enrolled pregnant women with CVD to a standardized diagnostic testing and assessment protocol. (Figure 1) Specific detailed cardiac and obstetric data were collected during the antepartum, intrapartum and postpartum periods. Each woman was assigned a STORCC color code of perceived risk at a monthly multidisciplinary conference comprised of representatives from cardiology, maternal fetal medicine and obstetric anesthesia. In 250 pregnancies of women with CVD, the standardized care protocol was followed in 136 and routine care in 114. The median age of the subjects was 32 years, and the most common form of heart disease was congenital heart disease (77%). Of the 136 standardized care patients, 22% were classified as high-risk, and 78% as low-risk. Among the high-risk group, 12% experienced a prior adverse cardiac event, 8% had a resting left ventricular outflow tract gradient ≥ 30 mm Hg and one had cyanosis (room air oxygen saturation <90%). Women enrolled in standardized care protocol had high compliance with 2nd and 3rd trimester visits (93%) and post-partum visits (76%). Maternal cardiac complications occurred in 10%. Outcomes did not differ between the standardized care and routine care cohorts; this remained true after adjusting for type of heart disease or disease complexity. The STORCC cardiac and obstetric color codes were predictive for adverse outcomes within each respective category (p = 0.02, 0.01). (Figure 2) The STORCC protocol for prospective diagnostic testing and follow-up of pregnant women with CVD was successfully established and compliance was high. The strength of a standardized testing and care protocols as well as detailed classification of labor and delivery characteristics allows for robust analyses into specific questions regarding mode and timing of delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)