College standards to reduce maternal deaths from cardiac disease

New standards of care for pregnant women and new mothers with heart disease are being launched today by the Royal College of Physicians and Surgeons of Glasgow.

Professor Hazel Scott, Vice President (medical) at the College said heart disease is one of the leading causes of maternal death. New standards ‘Addressing the Heart of the Issue’ have been developed by College to support enhanced care of women of childbearing age with cardiac disease. These will be presented in the College today (9 December) at the Glasgow launch of the MBRRACE UK 2016 report, ‘Saving Lives, Improving Mothers’ Care’. 

The standards were developed in response to findings from the MBRRACE UK 2014 report, which showed that the number of indirect maternal deaths - not as a result of complications directly associated with pregnancy - had not seen any significant decrease in the last ten years.  The report called for coordinated action across a wide range of health services to address the problem.

In September 2016, the Royal College of Physicians and Surgeons of Glasgow hosted a meeting with stakeholders from all territorial health boards in Scotland and expert clinical leads in cardiology and obstetrics, to discuss how best to tackle inequalities in health care across Scotland and provide improved, safe women-centred care. 

The outcome of that meeting has led to the development of key standards which outline the best practice of care for women with cardiac disease, before, during and after pregnancy.  In particular, they call for:

1. Enhanced consideration of the potential for complication for women with known heart disease at the time of pre-pregnancy planning

2. Greater use of specialist advice for pre-pregnancy counselling and guidance during early pregnancy

3. Clear lines of referral and an identified inter-professional team within each health board, with defined escalation pathways to tertiary centres

4. Greater inter-disciplinary communication throughout pregnancy and especially at the time of presentation with new symptoms

The 2016 ‘Saving Lives, Improving Mothers’ Care’ report being launched at the College, includes further study by the University of Oxford of the care of 153 women who died from heart disease during or after pregnancy in the UK and Ireland between 2009 and 2014. In some of these instances women presented with typical symptoms of a heart attack (severe central chest pain spreading to the left arm or back), or other heart problems (severe breathlessness when lying flat) but did not seek advice from their doctor or midwife because they did not consider they could be at risk of, or connect the symptoms to heart problems. 

A significant proportion of women who died also had a pre-existing condition before embarking on pregnancy, yet were not flagged as ‘high risk’ and so did not receive the specialist care they needed.

The Royal College of Physicians and Surgeons of Glasgow believes that implementation of the new standards ‘Addressing the Heart of the Issue’ will safeguard against inequalities of care through better access to specialist advice, and that better planning and inter-professional care of women will ensure better patient outcomes.

The College calls on Health Boards to adopt these standards and reduce unnecessary morbidity and mortality from cardiac disease in women of child-bearing age. 

Professor Hazel Scott, College Vice President (Medical) said: "Every maternal death is a devastating blow to families, healthcare teams and the community. The Royal College of Physicians and Surgeons of Glasgow recognises that the key causes of such a death relate to the health of the whole woman, not her pregnancy. Heart disease is a particular area where physicians and obstetricians need to work better together to ensure the right care is given at the right time. 

"The creation of our new standards has involved such professional collaboration. The College calls on the Scottish Health Service to enable every woman of child bearing age in Scotland to have access to the protection afforded by the optimal use of the clinical team."

Chief Medical Officer for Scotland, Dr Catherine Calderwood, said: "I welcome the new standards of care for pregnant women and new mothers with heart disease that are being launched today by the Royal College of Physicians and Surgeons of Glasgow. The MBRRACE report published this week and the 2014 report have highlighted the risks of heart problems for pregnant women, and this is an area where, with awareness raising, prompt identification and multidisciplinary management of care can make a real difference to outcomes for pregnant women with cardiac disease. 

"These standards are the result of joint working between cardiologists and obstetricians across Scotland, and I welcome the standards and will work with colleagues in Health Boards to ensure that they are implemented across Scotland."

Professor Marian Knight, Maternal Programme Lead for MBRRACE UK said: "Whilst dying from heart disease in pregnancy or after childbirth is uncommon, women need to be aware that they may be at risk. Women with heart problems in pregnancy need the right care in the right place at the right time and by the right specialist team of doctors and midwives. These new standards will help ensure that women in Scotland get that best level of care." 

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