The development, implementation and evaluation of an integrated multidisciplinary cardio-obstetrics care pathway for women with cardiovascular disease: a multicentric effectiveness study.

Within Western countries, the number of pregnancies and deliveries in women afflicted with acquired, congenital or inherited cardiovascular disease is significantly growing. Unfortunately, maternal heart disease is currently the leading cause of non-obstetric mortality in women during pregnancy, accounting for 33% of pregnancy-related deaths globally. To increase chances of a successful pregnancy with safeguarding maternal and fetal health on the long term, the provision of care by a multidisciplinary pregnancy heart team is recommended by several scientific and professional bodies. These European and American guidelines endorse the establishment of a joint cardio-obstetric outpatient clinic aiming to reduce the risk for adverse pregnancy outcomes. Such a Pregnancy Heart Clinic should integrate several components, including pre-conceptual counselling, perinatal risk assessment, antenatal care and post-partum follow-up. Hence, as the cohort of women of childbearing age with underlying CVD is ever growing, the evaluation of the effectiveness of a cardio-obstetric model of care is urgently needed. Although several guidelines recommend the creation of a Pregnancy Heart Clinic, these recommendations are currently largely eminence-based, urging the provision of empirical evidence as underpinning. To date, little empirical evidence is available on the patient-reported needs, organizational challenges and effectiveness of this care model in terms of feto-maternal outcomes. As maternal cardiovascular mortality and morbidity are to be considered a public health emergency, studies are needed to gain insight into successful strategies on how to create a dedicated clinic that incorporates multiple guideline-recommended components. Hence, this research project primarily aims to develop, implement and evaluate a multidisciplinary integrated care pathway for women with cardiovascular disease before, during and after pregnancy involving relevant stakeholders. To achieve this primary aim, several research objectives will be addressed in a consecutive project pathway. Three main research objectives are proposed. Firstly, we aim to gain insights into the needs, challenges and experiences of women with CVD before and after pregnancy using a qualitative study using semi-structured interviews. Secondly, we will establish a multicentric prospective registry of physiological and psychological outcomes in pregnant women with CVD during the post-partum period (i.e., fourth trimester). As part of this study, we will use a validated, standard set of parameters combining clinical outcomes, patient-reported outcomes and patient-reported experience measurements developed by ICHOM. Thirdly, we will develop an Integrated Care Pathway for women with CVD before, during and after pregnancy using the new European Pathway Association Framework. Furthermore, several scientific bodies propose to set-up a multidisciplinary cardio-obstetrics programs as a strategy to mitigate pregnancy-associated risks, limited data are currently available demonstrating the clinical and patient-reported effectiveness. Therefore, we will investigate the impact of the implementation of an integrated care pathway for women with CVD in terms of maternal, obstetric, fetal and patient-reported outcomes in the short -term post-partum period (i.e., fourth trimester).

Keywords:HEALTH CARE ORGANISATION, CARDIOLOGY, NURSING, PREGNANCY

Disciplines:Cardiology, Obstetrics, Nursing in general medicine and medical specialisms, Vascular diseases, Hospital science and management