News | Cardiovascular Education | December 04, 2023

Minneapolis Heart Institute Foundation Research Advances Understanding of Health Equity and Outcomes in Fourth-Trimester Care for Women

Research focused on health equity outcomes in the fourth trimester of pregnancy has been published in the journal Circulation by the Minneapolis Heart Institute Foundation. The study found low levels of guideline-directed care related to conditions that develop during pregnancy, as well as significant disparities in women of color and those on Medicaid who were less likely to receive follow-up to reduce lifetime risk for CVD.

Research focused on health equity outcomes in the fourth trimester of pregnancy has been published in the journal Circulation by the Minneapolis Heart Institute Foundation. The study found low levels of guideline-directed care related to conditions that develop during pregnancy, as well as significant disparities in women of color and those on Medicaid who were less likely to receive follow-up to reduce lifetime risk for CVD. Image courtesy: Minneapolis Heart Institute Foundation


December 4, 2023 — The Minneapolis Heart Institute Foundation (MHIF), an internationally renowned cardiovascular research organization, has announced the publication of original research focused on health equity and outcomes in the fourth trimester of pregnancy (defined as the first 12 weeks postpartum/after delivery). Cardiovascular disease (CVD) is the leading cause of maternal death, accounting for more than one-third (33 percent) of pregnancy-related deaths. The fourth-trimester study found low levels of guideline-directed care related to conditions that develop during pregnancy, as well as significant disparities in women of color and those on Medicaid who were less likely to receive follow-up to reduce lifetime risk for CVD. The full article, “Fourth Trimester: Assessing Women’s Health Equity and Long-Term Cardiovascular Outcomes in a Large Midwestern Health System in 2021,” was published in the American Heart Association (AHA) journal Circulation.

“Gestational diabetes, gestational hypertension and preeclampsia are all significant pregnancy-related risk factors for developing cardiovascular disease in one's lifetime,” said Courtney Jordan Baechler, MD, MS, medical director of Health Equity and Health Promotion at MHIF and senior author of the publication. She added, “This study found that many women who developed these pregnancy-related conditions did not have evidence-based follow-up to adequately reduce their long-term risk. Given the known cardiovascular disparities among women along racial and socioeconomic lines, postpartum care is a critical step toward prevention.” 

Blood pressure screening is one example of an important assessment in the first trimester following delivery, especially in women with preeclampsia (a serious blood pressure condition that develops during pregnancy). In the study only 61 percent were prescribed guideline-directed medications and only 12 percent received a referral for risk reduction to a cardiologist, primary care program, dietitian or lifestyle behavior change program. There were also differences noted across racial groups. Women who identified as American Indian/Native American were least likely to have their blood glucose screened if they had a diagnosis of gestational diabetes and have their blood pressure measured if they were diagnosed with gestational hypertension (high blood pressure).

“It's important that we advocate for innovative, creative models that best meet the needs of the patients experiencing the largest disparities,” said Baechler. She continued, “The goal is to support women-- many of whom are balancing young children, careers, suboptimal insurance coverage, health care distrust, lack of transportation, and other known social barriers of heart health and care access."

The fourth-trimester study was designed to understand the proportion of women who received guideline-directed care within six months postpartum, including receiving medication or risk-reduction resources for elevated blood pressure and/or blood glucose. The study also compared rates of care between racial groups to assess health equity. This research was conducted as a single-center study evaluating data from patients who received postpartum care (at least one visit in six months post-delivery) and delivered at an Allina Health facility between Jan. 1 and Dec. 31, 2021.

This research was supported and accelerated by the generosity of the Dubes Family, who provided funding for the MHIF women’s clinical research intern.

The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.

Scientific Innovation and Research – MHIF is a recognized leader across all specialties of heart and vascular research. Each year, MHIF leads more than 220 research studies with more than 2,200 patients and publishes more than 350 articles to share learnings from research. MHIF research has improved the standard of care around the world through protocols like Level One for heart attack, which significantly improved outcomes and survival for patients.

Education and Outreach – MHIF provides more than 11,000 hours of education each year putting its research into practice to improve outcomes among health care providers. This commitment extends to patients and caregivers through a number of community health and education events to raise awareness of heart care and research, engaging individuals in their own health.

The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and engages in cutting-edge research initiatives with its physician partners from the Allina Health Minneapolis Heart Institute at Abbott Northwestern and United Hospitals, and at 38 community sites across Minnesota and western Wisconsin.

More information: www.mplsheart.org


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