From Hypertensive Pregnancy to Heart Health: Understanding and Addressing Multi-Level Barriers to Cardiovascular Health after Hypertensive Disorders of Pregnancy - Modified Project Summary/Abstract Section Hypertensive disorders of pregnancy (HDPs) affect 10% of pregnancies in the United States and are associated with future cardiovascular disease (CVD) risk, with significantly higher prevalence and worse outcomes among Black women and women with low incomes. Timely identification and management of CVD risk factors (e.g., blood pressure control) after HDPs leads to substantial and sustained improvements in cardiovascular health. Yet only 25-50% of patients receive recommended care in the year after HDPs, with lower rates for Black women and women with low incomes. Therefore, inadequate care after HDPs is a critical missed opportunity to promote cardiovascular health in women. Unfortunately, efforts to improve cardiovascular health after HDPs are limited by key gaps in evidence and approach. First, there is a general need for more data on CVD risk and cardiovascular health in Black women and women with low incomes. Second, such data must be followed by rigorous implementation of evidence-based interventions with stakeholder engagement. In response, Dr. Murray Horwitz has developed a plan to address large knowledge gaps, work with stakeholders to adapt an evidence-based intervention, and pilot-test the intervention, to improve cardiovascular health after HDPs. Her specific aims are to: (1) Examine the distribution of cardiovascular health (measured by Life’s Essential 8) in a nationwide sample of patients with prior HDPs (n~40,000), then identify key care gaps along the pathway from HDPs to cardiovascular health (i.e., receipt of ambulatory care (postpartum care, primary care), CVD risk assessment (i.e., glycemic control and lipids screening)), and finally identify predictors of a key point of drop-off (e.g., HDP subtype, health insurance coverage). These findings will inform adaptations to a postpartum patient navigation intervention, to ensure that it addresses modifiable barriers to cardiovascular health after HDPs. (2) Conduct stakeholder-engaged qualitative research in 2 health care settings, to contextualize care pathways in the year after HDPs, then identify potential implementation barriers for the planned patient navigation intervention. Findings will be used to refine the implementation strategy for the intervention, prior to pilot testing. (3) Conduct a pilot randomized controlled trial to test the feasibility and acceptability of a postpartum patient navigation intervention, adapted to improve cardiovascular health after HDPs, in a large safety-net hospital (n=30/group, 60 total). Trial results will inform further improvements to the intervention and implementation strategy, to be followed by multi-site effectiveness testing. Her research aims inform her training goals, as follows: (1) Develop expertise in advanced modeling techniques, specifically mixed-effects modeling and risk prediction; (2) Establish competency in community engagement and implementation science; and (3) Gain skills in pragmatic clinical trial design & conduct. This award will facilitate Dr. Murray Horwitz’s long-term goal of becoming an independent investigator who develops and disseminates interventions that improve cardiovascular health among women.
