A significant number of life-threatening complications in pregnant women with heart disease could be prevented altogether, according to new findings published by the Journal of the American College of Cardiology.
Women with heart disease are at an especially high risk of experiencing serious cardiac events (SCEs) while pregnant, the study’s authors explained, and understanding such complications can help healthcare providers develop new strategies to improve outcomes.
Researchers examined the pregnancies of more than 1,300 women with heart disease who were part of the CARPREG (Canadian Cardiac Disease in Pregnancy) study. The women were all treated at one of two facilities in Canada from 2004 to 2014. SCEs the team focused on included cardiac death, cardiac arrest, ventricular arrhythmias, congestive heart failure, MI, stroke, valve thrombosis, urgent cardiac interventions and more.
Overall, 3.6% of pregnancies involved SCEs, and the most common were cardiac death and cardiac arrest, heart failure, arrhythmias and urgent cardiac interventions. Based on “a previously established tool first used in the Harvard Medical Practice Study and modified in subsequent studies,” in addition to guidance from a minimum of two cardiologists, the authors found that 49% of the identified SCEs were preventable.
SCEs were viewed as preventable due for one of four reasons: healthcare provider management factors, patient-related factors, system-related factors and iatrogenic factors.
A majority (74% ) of all preventable SCEs occurred due to healthcare provider management factors, and 17% were due to patient-related factors. Another 4% each were due to system-related factors and iatrogenic factors.
“Approximately one-half of all the SCEs were preventable, and they were most commonly due to failures in the provision of care by health care teams or patient-related factors,” wrote lead author Birgit Pfaller, MD, Toronto General and Mount Sinai Hospitals in Toronto, and colleagues. “These findings highlight the urgent need for interventions to educate providers and patients about the risk for pregnancy in this high-risk group of women.”
Pfaller and colleagues also noted that smaller facilities were associated with more healthcare provider management factors—issues such at delays in patient care or the failure to transfer a high-risk patient. On the other hand, patient-related factors were more common when patients were being treated at larger tertiary care centers.
“There are likely a number of reasons that the types of errors differ at smaller medical centers compared with tertiary care centers,” the authors wrote. “For instance, smaller centers are more likely to encounter pregnant women with previously undiagnosed heart disease, and this may contribute to a higher proportion of physician-related factors affecting outcomes. Variability in the types of preventable errors between centers also means that different interventions may be more effective at different sites.”
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.