Standardized Outcomes in Reproductive Cardiovascular Care: The STORCC Initiative

Abstract Background Validated protocols for diagnostic testing and management of pregnant women with cardiovascular disease (CVD) do not exist. Our objective was to establish a prospective standardized protocol for the clinical evaluation of pregnant women with CVD. Methods and Results The Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) initiative prospectively enrolled pregnant women with CVD into a standardized diagnostic testing and assessment protocol. Detailed cardiac and obstetric data were collected during the antepartum, intrapartum and postpartum periods. Each woman was assigned a STORCC color code of perceived risk at a monthly multidisciplinary conference. In 250 pregnancies of 207 women with CVD, the standardized care protocol was followed in 136 and routine care in 114. The median age of the subjects was 32 years, and the most common form of heart disease was congenital heart disease (77%). Women enrolled in standardized care protocol had high compliance with 2nd and 3rd trimester visits (93%) and post-partum visits (76%). Maternal cardiac complications occurred in 10%. The STORCC cardiac and obstetric color codes predicted adverse outcomes within each respective category (p = 0.02, 0.01). Conclusions The STORCC protocol for prospective diagnostic testing and follow-up of pregnant women with CVD was successfully established and compliance was high. The strength of a standardized testing and care protocol as well as detailed classification of labor and delivery characteristics allow for robust analyses into specific questions regarding testing protocols, and mode and timing of delivery.