Maternal heart rate collection pre- and post-cardiac screening guideline implementation in an outpatient obstetrics office

Abstract

The California Maternal Quality Care Collaborative (CMQCC) proposed an algorithm to reduce maternal mortality by screening for cardiac disease in pregnancy, including use of maternal heart rates. The effect of this guideline was assessed at an outpatient obstetrics office by studying rates of heart rate screening before and after implementation. This study reviewed 100 return in-person prenatal visits monthly from January 2019 to November 2021. Maternal heart rate, demographics, and presence of chronic hypertension or cardiac disease were noted. Rates of heart rate collection were compared pre- and post-guideline implementation. Per the CMQCC guideline, a resting heart rate of ≥ 110 bpm was deemed high enough to warrant further evaluation. This retrospective cohort included 3,478 visits (100 visits per month, fewer visits in April and May 2020 due to COVID19 pandemic). Several visits (n=382, 11%) were to patients with chronic hypertension and 159 (4.6%) had underlying cardiac disease. Overall, 1798 (51.7%) visits recorded a maternal heart rate, while 1680 (48.3%) did not. More visits had heart rates recorded post- than pre-guideline (67.6% versus 21.4% of visits, respectively; p < 0.001). Maternal heart rates ≥ 110 bpm were recorded at 130 visits (3.7%). Pre-guideline, 29.5% of patients with heart disease and/or chronic hypertension had heart rate recorded compared to 20.1% of patients without these conditions (p=0.005). Post-guideline, patients with heart disease and/or chronic hypertension were more likely to have heart rate recorded compared to those without these conditions (78.8% versus 65.8%, p < 0.001). Elevated heart rates ≥ 110 were recorded at 34 of 308 (11.0%) visits to patients with known hypertension and/or cardiac disease, compared to 96 out of 1490 (6.4%) to patients without these diagnoses (p=0.005). Maternal heart rate screening significantly increased after guideline implementation. Patients with underlying cardiac disease and/or chronic hypertension were nearly twice as likely to have a heart rate ≥ 110 bpm when heart rate was assessed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)