Development and Implementation of a Pregnancy Heart Team at a Southeastern US Tertiary Hospital: A Qualitative Study.

BACKGROUND: The United States has seen a significant rise in maternal mortality and morbidity associated with cardiovascular disease over the past four decades. Contributing factors may include an increasing number of parturients with comorbid conditions, a higher rate of pregnancy among women of advanced maternal age, and more patients with congenital heart disease surviving into childbearing age and experiencing pregnancy. In response, national medical organizations have recommended the creation of multidisciplinary obstetric-cardiac teams, also known as pregnancy heart teams, to provide comprehensive preconception counseling and coordinated pregnancy management extending through the postpartum period.

OBJECTIVE: We sought to describe the development and implementation of a pregnancy heart team for parturients with cardiac disease at a southeastern US tertiary hospital.

STUDY DESIGN: This was a qualitative study with health care team members involved during the pregnancy heart team formation. Semi-structured interviews were conducted between April-May 2022, professionally transcribed, and the responses were thematically coded for categories and themes utilizing constructs from The Consolidated Framework for Implementation Research.

RESULTS: Themes identified included intentional collaboration to improve outpatient and inpatient coordination through earlier awareness of patients meeting criteria and via documented care planning. The pregnancy heart team united clinicians around best practices and coordination to promote pregnancies being successful and safer, not only minimizing maternal health risks. Developing longitudinal care plans was critical among the pathway team for building on collective expertise and clarity for those on shift, to reduce hesitancy and achieve timely, vetted practices without additional consults. Establishing a proactive approach of specialists offering their perspectives was viewed as positively contributing to a culture of "speaking up." Barriers to the successful development and sustainability of the pregnancy heart team include unmet administrative needs and clinician turnover, within a context of short staffing and high workload.

CONCLUSIONS: This study describes the process of developing and implementing a pregnancy heart team at one institution, offering insights for future multidisciplinary care for maternal cardiac patients. Establishing pregnancy heart teams can enhance quality care for high-risk patients, foster learning and collaboration among physician and nursing specialties, and improve coordination to manage complex maternal cardiac cases.