Reducing late maternal death due to cardiovascular disease - A pragmatic pilot study

Background:
Late maternal mortality (up-to 1-year postpartum) is poorly reported globally and is commonly due to cardiovascular disease (CVD). We investigated targeted interventions aiming at reducing peripartum heart failure admission and late maternal death.
Methods and results:
Prospective single-centre study of 269 peripartum women presenting with CVD in pregnancy, orwithin 6-months postpartum. Both cardiac diseasematernity (CDM) Group-I andGroup-IIwere treated by a dedicated cardiac-obstetric team. CDM Group-II received additional interventions: 1. Early (2–6 weeks) postpartum follow-up at the CDM clinic and immediate referral to dedicated CVD specialist clinics. 2. Betablocker therapy was continued in women with LVEFb45% while pregnant, or immediately started postpartum. Of 269 consecutive women (mean age 28.6 ± 5.9), 213 presented prepartum, 22% in NYHA groups III–IV and 79% in modified WHO groups III–IV. Patients were diagnosed with congenital heart disease (30%), valvular heart disease (25%) and cardiomyopathy (31%). The groups were similar in age, diagnosis, NYHA, modified WHO, BP and HIV, but Group-II had a higher rate of previously known CVD (p b 0.001) and a lower rate of being nulliparous (p b 0.0005). Of Group-I patients 9 died within the 12-month follow-up period versus one death in Group-II (p = 0.047). Heart failure leading to admission was 32% in Group-I versus 14% in Group-II (p = 0.0008), with Group-II having a higher betablocker use peripartum(p=0.009). Perinatalmortality ratewas 22/1000 live birthswith no differences between groups.
Conclusion:
Early follow-up in a dedicated CDMclinicwith targeted pharmacological interventions led to a significant reduction in peripartum heart failure admission and mortality.