(707) Results of diagnostic cardiac testing among pregnant persons with positive cardiovascular disease screening

Cardiovascular disease (CVD) is a significant cause of pregnancy-related morbidity and mortality, and global CVD risk assessment is a key step in mitigating this trend. Our practice includes referring patients with a positive CVD risk assessment for further cardiac testing. This study aimed to establish the rate of abnormal cardiac test results among this group.

Study Design: A prospective cohort study of 3 academic medical centers using our CVD risk assessment between 2020 – 2024. Primary outcome was an abnormal composite of cardiac test results (e.g. abnormal brain natriuretic peptide (BNP), electrocardiogram (EKG), or echocardiogram) calculated as a percentage. Bivariate analyses with two-sample t-tests and chi-square tests were performed to compare demographic and clinical characteristics between those with normal and abnormal results. Multivariate logistic regression was also fitted to evaluate the association between an abnormal test and patients' sociodemographic characteristics.

Results: A total of 16,900 patients had CVD risk assessment, of whom 334 (2%) had a positive and 16,655 (98%) had a negative result. Among those who screened positive, 207 (62%) went on to have diagnostic cardiac testing, including 117 BNP levels, 159 EKGs, and 81 echocardiograms. In this cohort, 78 (38%) had an abnormal composite cardiac test result, encompassing 14 (12%) abnormal BNP levels, 78 (38%) abnormal EKGs, and 2 (3%) abnormal echocardiograms. There were no significant differences between those with normal and abnormal composite cardiac test results with respect to age, ethnicity, insurance, medical conditions, symptoms, or total score on the CVD risk assessment (p > 0.05); however, in bivariate analysis, those with a heart rate above 110 were more likely to have an abnormal test (p=0.0458).

Conclusion:

Over one-third of patients with a positive CVD risk assessment had abnormal findings on subsequent cardiac testing. As there was inconsistency in the cardiac tests ordered following a positive screening, further research is required to determine which testing strategies have the highest yield for future use.