Testing a CVD screening tool in pregnant and postpartum women

在孕妇和产后妇女中测试 CVD 筛查工具

• 批准号: 10446998
• 负责人: Afshan Hameed
• 金额: $ 20.02万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10446998
• 关键词: Accounting; Admission activity; African American; African American population; Algorithms; Arrhythmia; Asian; Birthing Centers; California; Cardiovascular Diagnostic Techniques; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Clinic; Clinical; Consult; Disease; Early Diagnosis; Echocardiography; Ethnic Origin; Ethnic group; Evaluation; Exhibits; Feedback; Functional disorder; Future; Goals; Health Personnel; Heart Abnormalities; Hispanic; Hospitals; Hypertension; Hypertrophy; Inpatients; Intensive Care Units; Length of Stay; Maternal Mortality; Medicaid; Medical; Medical center; Medicine; Morbidity - disease rate; New York; Outpatients; Patients; Pharmaceutical Preparations; Postpartum Period; Postpartum Women; Predictive Value; Pregnancy; Pregnant Women; Prenatal care; Prevalence; Public Health; Pulmonary Hypertension; Quality of Care; Race; Reaction; Sampling; Screening Result; Screening procedure; Services; Signs and Symptoms; Site; Standardization; Stratification; Structure; Suggestion; Symptoms; Testing; Time; United States; Universities; Woman; base; cardiovascular disorder risk; cardiovascular risk factor; collaborative care; college; experience; follow-up; high risk; innovation; maternal morbidity; mortality; novel; peripartum cardiomyopathy; phrases; postpartum care; prediction algorithm; pregnancy disorder; pregnancy related death; pregnant; prenatal; prevent; racial and ethnic; racial diversity; screening; standard of care; tool

Cardiovascular disease (CVD) has emerged as the leading cause of maternal mortality in the United States. Approximately one third of the maternal deaths could have been prevented if CVD was diagnosed earlier by the health care providers. Women's CVD symptoms are often misdiagnosed or dismissed, causing delays in the recognition and treatment of CVD with a high risk for serious short- and long-term morbidity and mortality. In particular, African-American women exhibit three-to-four-fold higher mortality rate, presence of pre-existing CVD, hypertensive disorders of pregnancy, and peripartum cardiomyopathy compared to other racial/ethnic groups. A standardized screening tool could guide clinicians in identifying pregnant women at risk of CVD who require additional testing and follow up. The California Maternal Quality Care Collaborative developed a screening algorithm that guides stratification and initial evaluation of symptomatic or high-risk pregnant or postpartum women. This algorithm was implemented at two regional Level 3 birthing centers with high volume Medicaid patients and diverse racial ethnic mix: University of California, Irvine (UCI), and Albert Einstein College/Montefiore Medical Center (MMC), New York. In this new R21 we hypothesize that this algorithm has a potential in predicting CVD in pregnant women. We will test this idea by three aims. Aim 1 will validate a CVD screening algorithm in a sample of 3,000 pregnant and postpartum women at two regional hospital networks. We will conduct a retrospective medical chart review to describe the CVD screening algorithm's implementation at 23 clinic sites at UCI and MMC and obtain feedback on the experiences of the clinicians and patients. Aim 2 will determine the prevalence of CVD in pregnancy and postpartum women by race / ethnicity. Estimating a 1.5% true positive rate at UCI and a 3.0% true positive rate at MMC, we will identify approximately 75 women with CVD among 3,000 women screened. We will compare the prevalence among the African-American population with that of White, Hispanic, Asian, and Other/mixed race women. Aim 3 will calculate the positive predictive value of the CVD screening tool, each of its parameters, and combination of parameters. We will calculate the overall predictive value of the CVD algorithm and false positive and true positive values. We will calculate the positive predictive value of each of the 18 parameters of the algorithm or any informative combinations of the algorithm. Even though CVD is the leading cause of maternal mortality, a reliable clinical screening approach is lacking. This proposal will determine the predictive value of this innovative CVD screening tool, which has the potential to become the standard of care for all pregnant and postpartum women and, ultimately, decreasing VD related morbidity and mortality.

心血管疾病（CVD）已成为美国孕产妇死亡的主要原因。 大约三分之一的产妇死亡是可以避免的，如果心血管疾病是早期诊断， 卫生保健提供者。妇女的心血管疾病症状往往被误诊或驳回，造成延误， 识别和治疗具有严重短期和长期发病率和死亡率高风险的CVD。 特别是，非洲裔美国妇女的死亡率要高出三到四倍， CVD、妊娠期高血压疾病和围产期心肌病与其他人种/种族相比 组一个标准化的筛查工具可以指导临床医生识别有CVD风险的孕妇， 需要额外的测试和跟进。加州孕产妇质量护理协作组织制定了一项 筛选算法，指导分层和初步评估的症状或高危妊娠或 产后妇女。该算法在两个具有高容量的区域三级分娩中心实施 医疗补助患者和不同种族的种族混合：加州大学欧文分校（UCI）和阿尔伯特爱因斯坦 学院/Montefiore医学中心（MMC），纽约。在这个新的R21中，我们假设这个算法 预测孕妇心血管疾病的潜力。我们将通过三个目标来检验这个想法。目标1将验证 CVD筛查算法在两个地区的3，000名孕妇和产后妇女中进行 医院网络我们将进行回顾性病历审查，以描述CVD筛查 算法在UCI和MMC的23个临床站点的实施，并获得对 临床医生和患者。目的2将确定妊娠期和产后妇女心血管疾病的患病率 种族/民族。估计UCI的真阳性率为1.5%，MMC的真阳性率为3.0%， 在3,000名接受筛查的妇女中发现约75名心血管疾病妇女。我们将比较 非裔美国人与白色、西班牙裔、亚裔和其他/混合种族妇女之间的差异。目的 3将计算CVD筛查工具的阳性预测值，其每个参数，以及 参数的组合。我们将计算CVD算法的总体预测值， 真正的积极价值观。我们将计算18个参数中每一个的阳性预测值， 算法或算法的任何信息组合。尽管心血管疾病是 产妇死亡率，缺乏可靠的临床筛查方法。该提案将确定预测 这种创新的心血管疾病筛查工具的价值，有可能成为所有人的护理标准 孕妇和产后妇女，并最终降低VD相关的发病率和死亡率。