Dr. Marius Pienaar, a Gynecologist in Prince Rupert, is leading the way in testing a program focused on preventing cardiovascular disease (CVD). Dr. Pienaar was recently awarded funding by the Specialist Services Committee (SSC), which he is using to develop a program which screens women who have recently delivered at the hospital for their CVD risk. Certain complications in pregnancy (such as Pre-eclampsia, premature labour, diabetes, etc.) are known risk factors for future CVD. Dr. Pienaar has developed a referral and follow-up system to track and provide opportunity for at-risk women to receive testing of their cardiovascular risk at 6 months post-partum. Currently, this clinic in Prince Rupert serves many rural and remote surrounding communities on the north coast of BC.
Currently, there are very few opportunities for physicians to follow-up with and interact with the whole population, but there is a great opportunity to evaluate women when they are pregnant. Scientific knowledge and evidence have shown that pregnancy is a great place to evaluate cardiac risk. During a women’s pregnancy, data is collected, such as weight, blood pressure, family history etc., but currently, nothing is being done with this data. Furthermore, pregnancy itself acts as a ‘stress test’ for future cardiovascular disease. If a patient has one of six clinical conditions happen in pregnancy, she is flagged as high risk, and invited to attend the North Coast Maternal Health Clinic for further evaluation when the baby is 6 months old.
Dr. Pienaar has developed a software program which uses this data collected during a women’s pregnancy and uses this to assess for cardiovascular risks. Some basic measurements such as blood pressure and weight are recorded, and a panel of blood tests are performed, including blood lipids and glucose. This data is then entered into the program to calculate a risk score for future cardiovascular disease. Women with elevated risk are then offered interventions, and their primary care provider is informed of this risk.
Dr. Pienaar explains that if a woman has diabetes in pregnancy, she is at a higher risk of having diabetes later in life and should be tested 6 weeks to 6 months after pregnancy. Currently only about 20% of women are tested after pregnancy. Dr. Pienaar’s new software actively follows his patients and has created a referral and reminder system where every patient can be contacted and given opportunities to attend the North Coast Maternal Health Clinic for evaluation. A clinic in Kingston Ontario has developed a similar system, but Dr. Pienaar has taken this idea one-step further by developing the tracking software. Now in Prince Rupert, when a woman is discharged from the hospital after birth, she is evaluated by a nurse and is entered into the software. At risk women are encouraged to attend the postpartum clinic. At the end of every patient visit, the patient’s GP (and the patient herself) will receive a follow-up letter, which provides an overview of the testing and interventions that were completed, with information if further care if required.
Currently, Dr. Pienaar’s clinic seeks to intervene by providing clinical care to at-risk women as well as offering smoking cessation resources, on-site dietitians and diabetes nurses, etc. 100% of post-partum patients who are screened and are identified as having increased risk are offered the post-partum health clinic visit. The program is expected to increase patient-awareness of their own CVD risk, and support women to access additional health care services to help reduce their CVD risk with referrals and coordinate care back to their physicians. The clinic has been a success so far and is very efficient and cost effective. Dr. Pienaar has seen successful with his quality improvement project and hopes to make the program and software available across the province. There has already been interest from Fraser Health and the lower mainland to emulate the clinic model at other hospitals. This is the first such clinic in BC, and the first rural clinic in Canada specifically geared to evaluate cardiovascular risk in post partum patients.
"We have a golden opportunity to evaluate pregnant women with cardiovascular risk and this should not be missed."
Dr. Marius Pienaar