February is Heart Month, a time to raise awareness about the importance of cardiovascular care and shine a light on both the progress made, as well as issues that still need to be addressed. Unfortunately, heart disease is the leading cause of death among women, with one in three women dying from the disease annually.
Those aren’t comforting odds, and they are even more dire for Black women. In fact, greater than one in two Black women have heart disease, and they also have a higher chance of dying from cardiovascular disease (CVD), especially at a younger age. Social Determinants of Health like income level, food insecurity and access to housing can contribute to these kinds of significant disparities in cardiovascular health outcomes.
Pregnancy: A Window into Future Health
One of the most crucial indicators of a woman’s heart health comes during pregnancy. Pregnancy is nature’s cardiac stress test – adverse pregnancy outcomes, like preterm delivery, hypertensive disorders of pregnancy, and gestational diabetes, can translate to future risk for CVD, even up to 20 years postpartum.
CVD remains the leading cause of maternal death in Black women, largely driven by peripartum cardiomyopathy, which represents 45% of all pregnancy-related deaths between 6 weeks and a year postpartum. This is followed by hypertensive disorders of pregnancy, stroke and others. Research also shows that rates of high blood pressure during pregnancy have doubled in the past 12 years.
Certainly, mortality is of great concern, but so is morbidity, or rates of disease. For every maternal death, there are 75 to 100 more women who suffer a life-threatening maternal near-miss, with the greatest percentage seen in Black women. Even when adjusting for socioeconomic factors, Black women are two times as likely as white mothers to experience severe morbidity.
Addressing Heart Health Throughout the Continuum of Care
As healthcare professionals, we need to help women, especially women of color, get the care they need to address risk factors of CVD throughout the continuum of care. As soon as a patient enters the healthcare system, we must raise awareness about CVD and work with patients to address primary risk factors, like diabetes, smoking, obesity, hypertension, etc. Screening women and providing education in an ambulatory setting allows us to educate patients about the signs and symptoms of heart disease at any stage of pregnancy.
It is also important to reinforce routine monitoring during and after pregnancy. The U.S. Preventive Services Task Force has recently released guidance on tracking blood pressure throughout pregnancy. Showing women how to track their numbers and which warning signs to look for can help us address any issues early on. Given that less than 40% of women attend a postpartum visit, it is vital to educate women before they are discharged from the hospital.
Healthcare providers across the continuum of care – from pediatrics to cardio-obstetrics – play a role in optimizing health. And when we work together as a team, we’re better able to provide holistic care that leads to improved health outcomes. In fact, we’ve found that women can reduce their risk for CVD and maternal mortality by up to 80% through various lifestyle factors and through collaboration via a cardio-obstetrics/maternal heart team that improves outcomes across the care continuum, especially in the most vulnerable populations.
At Dignity Health in Arizona, we’ve established a Maternal Heart Council to provide specialized care for women with a pre-existing cardiovascular condition or those at high-risk for cardiovascular complications during and/or after pregnancy. This multidisciplinary group is focused on regionalizing care by getting high-risk women to regional hospitals that can handle their more significant needs, as well as implementing new protocols.
Our goal is to reduce the preventable morbidities and mortalities and disparities in care. To do so, we’re looking at each stage of the care continuum to find ways to improve outcomes from preconception to antepartum ambulatory care. We’ve developed quality improvement toolkits focused on decreasing rates of hemorrhage and preeclampsia and worked to standardize medical practices pre- and post-pregnancy. We’re also providing virtual care for women with high-risk pregnancies in rural areas.
By emphasizing ongoing medical care, promoting risk identification and reduction, and following mothers throughout the care continuum, we can reduce incidence of CVD, especially in the most vulnerable populations.
Watch Dr. Bond's recent Grand Rounds presentation on the intersection of maternal health and cardiovascular disease.