Erin Ferranti, PhD, MPH, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and the director of the Farmworker Family Health Program.

Erin Ferranti, PhD, MPH

New AHA Recommendations Encourage Improving Postpartum Cardiovascular Care

A recent publication from the American Heart Association (AHA) has provided a set of guidelines and tools to optimize postpartum heart health for women.

, fetal growth restriction, and others can portend a higher risk of future long-term complications, including greater lifetime risk of 

atherosclerotic cardiovascular disease (ASCVD)

. These risks are further exacerbated by disparities in socioeconomic status, geography, and race and ethnicity.

“Particularly, one of the big things we’re trying to push for is to get everybody to ask a woman if she’s given birth recently,” Erin Ferranti, PhD, MPH, associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University, director of the Farmworker Family Health Program, and co-author on the AHA recommendations, told 

 in an exclusive interview. “When you present in urgent care or an ER, that may not be one of the first questions providers think to ask, but if a woman presents with high blood pressure, it’s a critical question to know. That first week to two weeks post-delivery could be a very dangerous time period.”

The new recommendations aim to provide a pathway for evidence-based care implementation during the postpartum phase, which has been historically overlooked in its potential for cardiovascular risk. The present document is its second iteration following a secondary literature review and ongoing dialogue with clinical and community organizations. The recommendations are collected into 4 major points: standardizing postpartum systems, interdisciplinary care and engagement, advocacy and policy expansion, and risk factor identification and monitoring.

Recommendation 1: Standardizing Postpartum Systems

The crux of this first recommendation is the education of both patients and specialists on the risks of cardiovascular disease postpartum, encouraging outreach from clinicians to schedule follow-up visits after delivery and suggesting further training in cardio-obstetrics. The recommendations stress that a functional cardio-obstetrics team requires cardiologists, obstetricians, maternal-fetal medicine specialists, primary healthcare providers, geneticists, pharmacists, obstetric anesthesiologists, neonatologists, and a list of other members to maximize commitment and effective communication.

Recommendation 2: Interdisciplinary Care and Engagement

This segment of the document focuses on policy gaps, such as Medicaid reimbursement and training reimbursement, as well as referral pathways between hospitals and providers to enhance access to postpartum care. Hospitals are encouraged to select care team members to serve as “care champions”, who will establish and maintain regular communication with community partners.

Additionally, this section emphasizes the value of including family members and partners into postpartum education, fostering shared responsibility. Peer support groups, community-based organizations, and other options are also cited.

Recommendation 3: Advocacy and Policy Expansion

The backbone of this segment is the belief that US Federal law should require all states to provide Medicaid coverage through the first 12 months following birth to all patients who meet the Federal Poverty Level guidelines, including in-office, telehealth, home visits, emergency department, and urgent care visits. The writers suggest that clinicians develop educational and informational guidelines to disseminate among all obstetric clinicians who provide care to postpartum patients, as well as with potential stakeholders across the country.

Recommendation 4: Risk Factor Identification and Monitoring

The final suggestion advises clinicians to establish definitive strategies and mechanics for risk factor identification in postpartum patients. This includes advising clinicians of the increased cardiovascular disease risk after birth and the need for risk stratification to guide management algorithms. Additionally, factors such as the signs and symptoms of cardiovascular disease during pregnancy potentially imitating physiological changes of pregnancy are emphasized.

This section also highlights the importance of establishing health care systems that are sensitive to and regularly screen for social determinants of health that could limit care access or quality. Additionally, the document suggests that women with cardiovascular disease be evaluated prior to conception for discussions about risks, optimization of their cardiovascular health, and the need for regular surveillance.

“We traditionally have been very much in silos – endocrinology has their shop and cardiology has their shop, and we haven’t built systems that integrate our specialties well,” Ferranti said. “It has to come from the system to make those collaborations as priority. They need to be seamless. We need to have handoffs from provider to provider, specialty to specialty, so that women are not navigating these silo specialties on their own.”

Editors’ Note: Ferranti reports no relevant disclosures.

Bond R, Ferranti E, Lehnert T, et al. Advancing Maternal Health: Postpartum Care Recommendations and Resources Toolkit. 

https://www.heart.org/en/-/media/Files/Professional/Quality-Improvement/Maternal-Health/AHA_Advancing-Maternal-Health-Toolkit_FINAL_0426.pdf?sc_lang=en

Lewey J, Beckie TM, Brown HL, et al. Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: A scientific statement from the American Heart Association. Circulation. 2024;149(7). 

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Erin Ferranti, PhD, MPH, discusses the new guidelines and their implications for continued enhancement of both access to and outcomes of postpartum care.

Erin Ferranti, PhD, MPH

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