Screening algorithm nearly doubles detection of obstetric patients at risk for deadly heart disease

Orange Calif. – In a UC Irvine-led study of more than 30,000 pregnant and postpartum patients, a standardized risk-assessment algorithm dramatically improved the diagnosis of cardiovascular disease, the leading cause of U.S. maternal mortality.

The only risk-assessment toolkit for obstetric patients nearly doubled the odds of uncovering a potential for cardiovascular disease (CVD) compared with clinical evaluation alone, researchers reported in the American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine in May. The study also revealed a 48% increase in CVD diagnoses among patients flagged by the algorithm for follow-up screening vs. patients evaluated by a clinician.

Nearly one in four U.S. maternal deaths are the result of undiagnosed CVD, highlighting the urgent need for such enhanced detection and management tools during pregnancy and the postpartum period, said lead author Dr. Afshan B. Hameed, a UCI Health cardiologist and maternal-fetal medicine specialist who spearheaded the national study with colleagues at UC San Diego and the University of Missouri-Kansas City.

Early detection of underlying CVD risks enables clinicians to provide timely therapies that ultimately improve perinatal outcomes for mother and baby, said Hameed, a professor of cardiology as well as obstetrics and gynecology at the UC Irvine School of Medicine.

The study evaluated an 18-point risk-assessment algorithm that Hameed helped develop in 2017 with a working group of the California Maternal Quality Care Collaborative (CMQCC). It stratifies pregnant and postpartum patients at high and low risk for CVD. It can be integrated with a patient's electronic health record (EMR) to flag those at risk for CVD and recommend further testing.

Researchers at the three hospital networks — which had included the risk-assessment toolkit in their respective EMR systems — evaluated the charts of 31,232 pregnant and postpartum patients who received obstetrical care between September 2020 and August 2024.

Patients with a positive CVD risk assessment underwent diagnostic tests, including an echocardiogram, electrocardiogram or a test for B-type natriuretic peptide (BNP), a neurohormone secreted by the heart in response to ventricular stress. Clinicians could also refer patients for further testing, regardless of their risk score.

“We evaluated the frequency of abnormal test results among pregnant and postpartum individuals who screened positive using the risk-assessment tool compared to those who were referred for cardiac testing based on clinical judgment alone,” Hameed said. “Patients assessed for CVD using the tool had about 1.7 times the odds of having an abnormal test relative to those tested based on clinical judgment.”  

In addition, patients identified as risk-positive — at high risk — by the CVD tool were four times more likely to have an abnormal test result than patients who showed no CVD risk but had diagnostic testing for other reasons.

The toolkit, the only validated method for CVD risk assessment, is endorsed by the American College of Obstetricians and Gynecologists (ACOG) and is included in the Alliance for Innovation for Maternal Health's information on CVD and obstetrical care.

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.

“This study underscores the value of using a standardized cardiovascular risk-assessment tool for identifying pregnant and postpartum patients who would most benefit from testing for cardiovascular disease,” Hameed said. “Furthermore, integrating the tool into routine clinical practice can aid healthcare providers in prioritizing high-risk patients and ultimately fostering a proactive, preventive healthcare model.”

Study authors included Heike Thiel de Bocanegra PhD, MPH, Ashten Waks, MD, MSPH, Jenny Chang, MPH, and Omotayo I. Balogun, MPH, at UC Irvine; Maryam Tarsa, MD, MAS, and Marni B. Jacobs, PhD, MPH, at UC San Diego; Anna Grodzinsky, MDMS, and Karen L. Florio DO, MPH, at the University of Missouri-Kansas City.

The study was funded by 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).

Read more about UCI Health High-Risk Pregnancy Services or call 714-456-2911.

UCI Health, one of California’s largest academic health systems, is the clinical enterprise of the University of California, Irvine. The 1,317-bed system comprises its main campus UCI Medical Center, its flagship hospital in Orange, Calif., the UCI Health — Irvine medical campus, four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and a network of ambulatory care centers across the region. UCI Medical Center provides tertiary and quaternary care and is home to the only Orange County-based National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. Powered by UC Irvine, UCI Health serves nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook, Instagram, LinkedIn and X (formerly Twitter).

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