What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease in pregnancy (n=846). Intervention: California cardiovascular disease (CVD) screening algorithm. Primary outcome: Screen-positive rate.

What does this research mean for the field?

The California cardiovascular disease screening algorithm identifies an overall screen-positive rate of 8.3% and a true-positive rate of 1.5% among pregnant and postpartum women. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 1, 2020Open Access

California Cardiovascular Screening Tool: Findings from Initial Implementation

Key Result

The California cardiovascular disease screening algorithm identified an overall screen-positive rate of 8.3% among pregnant and postpartum women, with a true-positive rate of 1.5%.

Study Design

Type

Cohort (n=846)

Multicenter

Yes

Structured PICO

Does the California CVD screening algorithm effectively identify cardiovascular disease in pregnant and postpartum women?

Population

846 obstetrical patients (pregnant or postpartum) at academic medical centers in California and New York. Excluded: history of CVD known prior to pregnancy.

Intervention

California (CA) cardiovascular disease (CVD) screening algorithm

Outcome

Screen-positive rate

The California CVD screening algorithm identified an 8.3% screen-positive rate in a general obstetric population, highlighting its potential to identify women at higher lifetime risk of CVD, though high loss to follow-up limits definitive conclusions.

Limitations

Significant loss to follow-up testing between those with positive screening and completion of the recommended evaluation
Lack of a control group
Cannot draw conclusions regarding the algorithm's validation characteristics (sensitivity, specificity, or overall accuracy)
Selection bias due to the pilot nature of the study

Abstract

Abstract Objective American College of Obstetricians and Gynecologists (ACOG) recently published the California (CA) cardiovascular disease (CVD) screening algorithm for pregnant and postpartum women. We aim to prospectively determine screen-positive and true-positive rates of CVD among women across two populations. Study Design This is a prospective cohort study of obstetrical patients from April 2018 to July 2019 at academic medical centers in CA and New York (NY). We attempted to screen all patients at least once during their pregnancy care (prenatal or postpartum). Women who screened positive (“Red Flags,” >3–4 moderate risk factors, abnormal physical examination, and persistent symptoms) underwent further testing. The primary outcome was the screen-positive rate. Secondary outcomes included the true-positive rate and the strength of each moderate factor in predicting a positive CVD screen. Results We screened 846 women. The overall screen-positive rate was 8% (5% in CA vs. 19% in NY). The sites differed in ethnicity, that is, African American women (2.7% in CA vs. 35% in NY, p < 0.01) and substance use (2.7 vs. 5.6%, p < 0.04). The true-positive rate was 1.5% at both sites. The percentage of screen-positive patients who did not complete follow-up studies was higher in NY (70%) than in CA (27%). CVD was confirmed in 30% with positive screens with complete follow-up. Combinations of moderate factors were the main driver of screen-positive rates in both populations. Conclusion This is the first data describing the performance of the CVD screening algorithm in a general obstetric population. Factors, such as proportion of African American women affect the likelihood of a positive screen. The screening algorithm highlights patients at higher lifetime risk of CVD and may identify a group that could be targeted for more direct care transitions postpartum. Data may be used to design a larger validation study.

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