Evaluating risk of diagnostic delay in peripartum cardiomyopathy

PROJECT SUMMARY Black women are three times more likely to die as a result of pregnancy compared to White women in the US and are more likely to die from cardiovascular (CV) disease, including peripartum cardiomyopathy (PPCM). PPCM is a condition of new onset heart failure in the weeks to months after delivery in women without pre-existing CV disease. Black women are more likely to develop PPCM, less likely to recover, and have a higher mortality rate compared to White women. Strategies to improve early detection and treatment of PPCM hold promise to substantially reduce disparities in maternal deaths. Prior work has demonstrated that Black women are diagnosed with PPCM later in the postpartum period and that delayed PPCM diagnosis is associated with worse clinical outcomes. The primary purpose of this application is to determine the patient, provider, and practice (health system) factors that drive delays in PPCM diagnosis and to develop a pragmatic intervention to overcome these barriers. We will focus directly on the patient and provider experience to understand mechanisms of delays, which have not been researched in prior PPCM studies. We have the unique opportunity to collect patient-reported data from patients with recently diagnosed PPCM referred from the PPCM Consortium, a geographically diverse network of 60 sites across the US. We propose a mixed methods study to accomplish the following aims. First, we will determine the patient-reported factors contributing to delayed PPCM diagnosis using in-depth interviews and patient surveys and compare how these factors differ for Black and White women. Next, we will determine the provider and practice factors contributing to delayed diagnosis by conducting interviews and surveys with providers from specialties responsible for diagnosing PPCM, including obstetrics, primary care, and emergency medicine. We will then work with our stakeholder advisory board, consisting of patients with lived experience of PPCM, community members, cardiologists, obstetricians, and experts in public health and health equity to develop an intervention to reduce disparities in PPCM diagnosis and test the feasibility of the intervention among patients and providers at five clinical sites. Developing scalable interventions to improve timely diagnosis and treatment of PPCM has the potential to improve short and long-term maternal CV outcomes and may be generalizable to CV disease diagnoses in women unrelated to pregnancy.