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A study of pregnant women with heart disease has yielded a new risk index that improves on its predecessor by integrating general, lesion-specific, and delivery-of-care variables, investigators say.
“Compared with other published risk indices, including the original CARPREG [Cardiac Disease in Pregnancy] score, CARPREG II risk index had the highest discriminative and calibrative accuracy in our study group,” investigators said in a report published in the Journal of the American College of Cardiology.
First author on the report was Candice K. Silversides, MD, division of cardiology, University of Toronto pregnancy and heart disease research program, Mount Sinai Hospital/Sinai Health System.
The widely used, original CARPREG risk index was the first to predict maternal cardiac complications based on general clinical and echocardiographic data from the baseline antepartum visit, the researchers wrote in their report.
The new index developed by Dr. Silversides and her colleagues stems from a study of pregnant women with heart disease receiving care at two large Canadian obstetric centers.
Based on analysis of 1,938 pregnancies progressing beyond 20 weeks of gestation, the investigators found that cardiac complications were overall quite common in pregnant women with heart disease, occurring in 16% of participants. However, maternal cardiac deaths or cardiac arrests were rare, they said, occurring in just 11 (0.6%) of the pregnancies.
Most complications (64%) occurred in the antepartum period, according to the report.
Looking at patient data before or after 2001, investigators found the rates of most complications were consistent over time. However, rates of pulmonary edema decreased in the post-2001 period.
Multivariate analysis of these findings revealed 10 predictors of adverse cardiac events. Those included five general factors, including previous cardiac events or arrhythmia, four lesion-specific variables including pulmonary hypertension and coronary artery disease, and one process of care variable: late pregnancy assessment.
Only 4 of those 10 factors were included in the original CARPREG index, investigators noted.
In CARPREG II, each of the 10 factors is weighted with 1-3 points, depending on risk. For example, history of prior cardiac events was associated with a higher odds ratio, and so was assigned 3 points.
The predicted risk of primary cardiac events ranges from 5% for women with a total of 0-1 points, up to 41% for women with 5 or more points.
The finding that some predictors had higher odds ratios than others reinforces the “foundational role” of clinical assessment, investigators said in the report.
“There may be other factors that affect outcomes,” they wrote. “Risk assessment for the individual patient will need to integrate risk score estimates, known lesion-specific information, and clinical judgment by an experienced physician.”
Dr. Silversides and her coauthors reported that they had no relationships to disclose relevant to the contents of their report on the study.
SOURCE: Silversides CK et al. J Am Coll Cardiol. 2018;71:2419-30.
This update and expansion of the original CARPREG scoring system is a “useful starting point” for prediction of the risk of pregnancy in women with cardiac disease, according to Uri Elkayam, MD.
However, a detailed and lesion specific evaluation is still required for a more precise determination of risk for any given patient, Dr. Elkayam cautioned in an editorial accompanying the article.
Clinicians need to thoroughly understand how the patient’s cardiac condition could be affected by hemodynamic changes during pregnancy, labor, delivery, and the postpartum period, Dr. Elkayam added in his comments.
To fully take advantage of CARPREG II, clinicians need to take into account the limitations of the scoring system, he said, including the fact that it is based on population studies.
“Although the system presented is designed to examine all adverse cardiac events that could have an impact on maternal health, it is less effective for distinguishing between mild and easily manageable events that do not have serious effects on maternal or fetal outcomes and those that may be severe, life-threatening, or require hospitalizations or early delivery,” he wrote.
Dr. Elkayam is with the department of medicine, division of cardiovascular medicine, and the department of obstetrics and gynecology, University of Southern California, Los Angeles. These comments are derived from his editorial in the Journal of the American College of Cardiology . Dr. Elkayam reported he had no relationships relevant to the contents of this paper to disclose.
This update and expansion of the original CARPREG scoring system is a “useful starting point” for prediction of the risk of pregnancy in women with cardiac disease, according to Uri Elkayam, MD.
However, a detailed and lesion specific evaluation is still required for a more precise determination of risk for any given patient, Dr. Elkayam cautioned in an editorial accompanying the article.
Clinicians need to thoroughly understand how the patient’s cardiac condition could be affected by hemodynamic changes during pregnancy, labor, delivery, and the postpartum period, Dr. Elkayam added in his comments.
To fully take advantage of CARPREG II, clinicians need to take into account the limitations of the scoring system, he said, including the fact that it is based on population studies.
“Although the system presented is designed to examine all adverse cardiac events that could have an impact on maternal health, it is less effective for distinguishing between mild and easily manageable events that do not have serious effects on maternal or fetal outcomes and those that may be severe, life-threatening, or require hospitalizations or early delivery,” he wrote.
Dr. Elkayam is with the department of medicine, division of cardiovascular medicine, and the department of obstetrics and gynecology, University of Southern California, Los Angeles. These comments are derived from his editorial in the Journal of the American College of Cardiology . Dr. Elkayam reported he had no relationships relevant to the contents of this paper to disclose.
This update and expansion of the original CARPREG scoring system is a “useful starting point” for prediction of the risk of pregnancy in women with cardiac disease, according to Uri Elkayam, MD.
However, a detailed and lesion specific evaluation is still required for a more precise determination of risk for any given patient, Dr. Elkayam cautioned in an editorial accompanying the article.
Clinicians need to thoroughly understand how the patient’s cardiac condition could be affected by hemodynamic changes during pregnancy, labor, delivery, and the postpartum period, Dr. Elkayam added in his comments.
To fully take advantage of CARPREG II, clinicians need to take into account the limitations of the scoring system, he said, including the fact that it is based on population studies.
“Although the system presented is designed to examine all adverse cardiac events that could have an impact on maternal health, it is less effective for distinguishing between mild and easily manageable events that do not have serious effects on maternal or fetal outcomes and those that may be severe, life-threatening, or require hospitalizations or early delivery,” he wrote.
Dr. Elkayam is with the department of medicine, division of cardiovascular medicine, and the department of obstetrics and gynecology, University of Southern California, Los Angeles. These comments are derived from his editorial in the Journal of the American College of Cardiology . Dr. Elkayam reported he had no relationships relevant to the contents of this paper to disclose.
A study of pregnant women with heart disease has yielded a new risk index that improves on its predecessor by integrating general, lesion-specific, and delivery-of-care variables, investigators say.
“Compared with other published risk indices, including the original CARPREG [Cardiac Disease in Pregnancy] score, CARPREG II risk index had the highest discriminative and calibrative accuracy in our study group,” investigators said in a report published in the Journal of the American College of Cardiology.
First author on the report was Candice K. Silversides, MD, division of cardiology, University of Toronto pregnancy and heart disease research program, Mount Sinai Hospital/Sinai Health System.
The widely used, original CARPREG risk index was the first to predict maternal cardiac complications based on general clinical and echocardiographic data from the baseline antepartum visit, the researchers wrote in their report.
The new index developed by Dr. Silversides and her colleagues stems from a study of pregnant women with heart disease receiving care at two large Canadian obstetric centers.
Based on analysis of 1,938 pregnancies progressing beyond 20 weeks of gestation, the investigators found that cardiac complications were overall quite common in pregnant women with heart disease, occurring in 16% of participants. However, maternal cardiac deaths or cardiac arrests were rare, they said, occurring in just 11 (0.6%) of the pregnancies.
Most complications (64%) occurred in the antepartum period, according to the report.
Looking at patient data before or after 2001, investigators found the rates of most complications were consistent over time. However, rates of pulmonary edema decreased in the post-2001 period.
Multivariate analysis of these findings revealed 10 predictors of adverse cardiac events. Those included five general factors, including previous cardiac events or arrhythmia, four lesion-specific variables including pulmonary hypertension and coronary artery disease, and one process of care variable: late pregnancy assessment.
Only 4 of those 10 factors were included in the original CARPREG index, investigators noted.
In CARPREG II, each of the 10 factors is weighted with 1-3 points, depending on risk. For example, history of prior cardiac events was associated with a higher odds ratio, and so was assigned 3 points.
The predicted risk of primary cardiac events ranges from 5% for women with a total of 0-1 points, up to 41% for women with 5 or more points.
The finding that some predictors had higher odds ratios than others reinforces the “foundational role” of clinical assessment, investigators said in the report.
“There may be other factors that affect outcomes,” they wrote. “Risk assessment for the individual patient will need to integrate risk score estimates, known lesion-specific information, and clinical judgment by an experienced physician.”
Dr. Silversides and her coauthors reported that they had no relationships to disclose relevant to the contents of their report on the study.
SOURCE: Silversides CK et al. J Am Coll Cardiol. 2018;71:2419-30.
A study of pregnant women with heart disease has yielded a new risk index that improves on its predecessor by integrating general, lesion-specific, and delivery-of-care variables, investigators say.
“Compared with other published risk indices, including the original CARPREG [Cardiac Disease in Pregnancy] score, CARPREG II risk index had the highest discriminative and calibrative accuracy in our study group,” investigators said in a report published in the Journal of the American College of Cardiology.
First author on the report was Candice K. Silversides, MD, division of cardiology, University of Toronto pregnancy and heart disease research program, Mount Sinai Hospital/Sinai Health System.
The widely used, original CARPREG risk index was the first to predict maternal cardiac complications based on general clinical and echocardiographic data from the baseline antepartum visit, the researchers wrote in their report.
The new index developed by Dr. Silversides and her colleagues stems from a study of pregnant women with heart disease receiving care at two large Canadian obstetric centers.
Based on analysis of 1,938 pregnancies progressing beyond 20 weeks of gestation, the investigators found that cardiac complications were overall quite common in pregnant women with heart disease, occurring in 16% of participants. However, maternal cardiac deaths or cardiac arrests were rare, they said, occurring in just 11 (0.6%) of the pregnancies.
Most complications (64%) occurred in the antepartum period, according to the report.
Looking at patient data before or after 2001, investigators found the rates of most complications were consistent over time. However, rates of pulmonary edema decreased in the post-2001 period.
Multivariate analysis of these findings revealed 10 predictors of adverse cardiac events. Those included five general factors, including previous cardiac events or arrhythmia, four lesion-specific variables including pulmonary hypertension and coronary artery disease, and one process of care variable: late pregnancy assessment.
Only 4 of those 10 factors were included in the original CARPREG index, investigators noted.
In CARPREG II, each of the 10 factors is weighted with 1-3 points, depending on risk. For example, history of prior cardiac events was associated with a higher odds ratio, and so was assigned 3 points.
The predicted risk of primary cardiac events ranges from 5% for women with a total of 0-1 points, up to 41% for women with 5 or more points.
The finding that some predictors had higher odds ratios than others reinforces the “foundational role” of clinical assessment, investigators said in the report.
“There may be other factors that affect outcomes,” they wrote. “Risk assessment for the individual patient will need to integrate risk score estimates, known lesion-specific information, and clinical judgment by an experienced physician.”
Dr. Silversides and her coauthors reported that they had no relationships to disclose relevant to the contents of their report on the study.
SOURCE: Silversides CK et al. J Am Coll Cardiol. 2018;71:2419-30.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Key clinical point: A newly developed risk index enhances the ability to predict maternal cardiac complications by combining general, lesion-specific, and delivery-of-care variables.
Major finding: Investigators developed the CARPREG II risk index based on 10 predictors of maternal cardiac complications (5 general, 4 lesion-specific, and 1 related to delivery of care).
Study details: The CARPREG II Study, which included more than 2,000 prospectively enrolled consecutive pregnant women with heart disease seen at one of two large Canadian obstetric centers.
Disclosures: Authors reported that they had no relationships to disclose relevant to the contents of their report on the study.
Source: Silversides CK et al. J Am Coll Cardiol. 2018;71:2419-30.