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Welcome to the Becker's Healthcare podcast. I'm Mariah
Taylor, assistant editor, and I'm thrilled to interview
Suzette Graham Hill, lead of cardio obstetrics program
at NYC Health and Hospitals, Kings County.
Suzette, thank you so much for joining me
today. I'm so excited to learn more about
how hospitals are addressing cardiovascular
disease in pregnant patients. But before we dive
in, I'd love to hear just a little
bit more about you and your background.
Well, a physician specialist here at Kings County
Hospital
taking care of adult patients,
in particularly
pregnant women who are referred from the obstetrics
department
where we see them in our heart health
center, and we evaluate them, especially if they
have preeclampsia
or chronic hypertension.
We evaluate them, with a physical exam as
well as set up an echocardiogram
as well as blood work to prevent any
cardiovascular
complications.
So, I do that as well
as read echocardiograms
and perform transesophageal,
echocardiograms.
So I do a whole host of things
to take care of adult patients.
Excellent.
And as probably many of our listeners know,
cardiovascular
disease is the leading cause of pregnancy related
deaths right now. Can you tell us a
little bit more about the scale of this
problem and why hospital leaders are taking notice?
Well, as you said, cardiovascular
disease is the leading cause of pregnancy related
deaths in The United States. And these deaths
we are noticing
are happening after delivery, and they are and
they are preventative
with better screening and follow-up.
We've noticed that most of the deaths are
related to cardiomyopathy
and hypertensive,
disorders.
So we in at Kings County Hospital, we
are trying to,
stop or trying to,
do the workup so that we could prevent
cardiovascular
complications
because we recognize that most of the deaths
are occurring
one year postpartum.
And we also noted that black women are
disproportionately
affected
that are are significantly affected by hypertensive
heart disease, and they're having early mortality.
So the hospital leaders
are taking notice to all of these
causes of, morbidity and mortality
because these outcomes
can largely be preventable
with earlier screening,
better follow-up,
and stronger coordination
between the obstetrics department and cardiology.
Hospital leaders have noted that this is no
longer a clinical issue.
It is a systems and quality issue that
we're all working together to forestall.
I love that. And let's dive into that
just a little bit deeper. What are hospitals
doing in care and operations to kind of
meet this demand?
Well, this shift means that the hospitals
have they must move beyond
traditional
six weeks, the postpartum model. Maternal health care
had now requires coordination
between the obstetrics department,
cardiology, and primary care. The traditional models of
that six weeks is no longer effective. So
cardiovascular
risk is continuing
to rise post six weeks after a woman
has their baby.
So the hospitals
must build systems
that integrate
cardiology,
maternal fetal medicine,
nursing, and primary care. And it also
requires an investment in blood pressure monitoring for
the moms,
patient education,
and smoother discharge
planning.
So from an operational
perspective,
it shifts maternal care from a short term
event to a long term
population health strategies.
Leaders in our hospital
view maternal cardiovascular
health as part of a quality improvement
and a risk management
effort to take care of our patients.
Amazing. And I know you guys are doing
an amazing job of really improving
your rates and the access to care for
these patients. So can you give us a
little bit more details about what kind of
initiatives or programs are showing success?
Well, we have formed a cardio obstetric team,
which involves obstetrics and cardiology.
We also are working with the maternal health
team to,
have remote blood pressure monitoring,
And we're also working with the obstetrics team
to have automatic
cardiology
referrals for those women with preeclampsia.
When hospitals standardized
follow-up
and extend postpartum care, we recognize
outcomes improve.
The American Heart Association
has issued a guidance
sub supporting
cardio anesthetic teams, which brings the cardiologist
and the obstetrics teams together
for those high risk patients
identified in the OBGYN
department.
So what we're doing, we're we're implementing
remote blood pressure monitoring
and programs
that to reduce the postpartum
complication
by identifying
high blood pressure early. Some of the hospitals
schedule cardiology
follow-up appointments before discharge,
which improves our continuity of care.
States are expanding Medicaid coverage to twelve months
postpartum
and also improving follow-up access.
These interventions
have been shown that structured systems
can
significantly
reduce
preventable deaths.
Amazing.
And now for all of our listeners out
there who are hearing you and your passion
and thinking, I wanna do better at our
hospital. I wanna make something happen. What is
your recommendation
for an area in heart care or patient
experience that they can make the biggest difference?
Well, hospitals can make the biggest difference by
improving
early risk
identification
and postpartum follow-up.
We we're standardizing our cardiovascular
screening
during pregnancy
to help identify
those high risk women sooner.
We're implementing
automatic referrals to cardiology
for those women with preeclampsia
or severe hypertension
to prevent long term complications.
Clear communication
at discharge
we've identified is the key, including scheduling follow-up
visits before the patients leave the hospital.
Also, it will improve the patient's outcomes.
Finally,
we're trying to address the social barriers
such as transportation,
insurance
gaps, and health care literacy
that because we recognize that this can dramatically
improve continuity
of care. The greatest opportunity
lies in coordinating
patient centered systems
rather than isolated
interventions.
Incredible.
Well, this has been a really informative discussion,
and I just love hearing all the passion
that you bring to this. So thank you
for joining me and sharing everything on the
podcast today.
Thank you.