The ACC Reproductive Health and Cardio-Obstetrics (RHCOB) Cardiovascular Team Workgroup presented "Strengthening Pregnancy Outcomes Utilizing Advanced Practice Providers in Cardio-Obstetric Care: A Case Report" at the 10th International Congress on Cardiac Problems in Pregnancy (CPP 2026), held from April 16th through 19th, 2026 in Barcelona, Spain.¹ This presentation reflected the workgroup's ongoing commitment to advancing education, collaboration, and evidence-based care in the growing field of cardio-obstetrics.

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in pregnant patients in the United States, with disproportionate impacts on underserved populations. Cardiac conditions in pregnancy often persist and influence long-term health in these patients.² With rising demand, workforce limitations, lack of formal cardio-obstetric training/competences, and care fragmentation, there are challenges to timely, equitable access to cardiac care during and after pregnancy.³

Advanced practice providers (APPs), including nurse practitioners, PAs, clinical nurse specialists, and certified nurse midwives, are uniquely positioned to address these gaps through integrated, team-based models of care.⁴ As integral members of the multidisciplinary cardio-obstetric team, APPs can enhance access to care, facilitate risk stratification and care coordination, expand patient education and remote monitoring, and help close critical gaps in care that influence cardiovascular (CV) outcomes in pregnant patients. Despite their potential contributions, APPs remain underutilized within cardio-obstetric programs at many institutions.

The following case report highlights the critical role of APPs within multidisciplinary cardio-obstetric teams, emphasizing coordinated care across the continuum of pregnancy, delivery, and the postpartum period (Figure 1). This case underscores how structured, team-based models and proactive surveillance improve outcomes in pregnant patients and reduce the care burden.^4-6

Figure 1: Case Report Highlighting the Critical Role of APPs Within Multidisciplinary Cardio-Obstetric Teams

Courtesy of Atrium Health/Advocate Health, Charlotte, North Carolina. Click to Enlarge.

The APP Role Across the Pregnancy Continuum^6-8

APPs play a central role in delivering longitudinal, patient-centered care that spans preconception through the postpartum period. Their impact is particularly evident in three key domains: 1) preconception and early pregnancy; 2) the antenatal period and delivery planning; and 3) the postpartum period and fourth trimester.

Preconception and Early Pregnancy: Proactive Risk Identification

APPs can facilitate early CV risk assessment, optimize comorbid conditions, and provide counseling on pregnancy and reproductive life planning. In the presented case, engagement with APP-led care enabled risk awareness, although gaps in follow-up highlighted ongoing challenges in care continuity and patient engagement, and ultimately an unplanned pregnancy.

Key contributions include:

• CV risk stratification and optimization;
• Medication reconciliation and safety counseling focusing on health management for the pregnant patients and safety for the fetuses;
• Coordination with maternal-fetal medicine (MFM), obstetrics (OB), and subspecialty teams;
• Patient education tailored to health literacy and barriers (medications, activity, warning signs);
• Contraception counseling;
• Coordinating care with primary care and family medicine for transition in the fourth trimester; and
• Increased access to care.

Antenatal Period and Delivery Planning: Coordinated Multidisciplinary Care

During pregnancy, APPs can facilitate coordinated care across specialties by supporting shared management decisions, longitudinal surveillance, and structured delivery planning within a multidisciplinary team. This collaborative approach minimizes care fragmentation and enhances continuity and coordination of care for patients and their families.

Key contributions include:

• Monitoring of patients during pregnancy and through the fourth trimester;
• Planning and, in some cases, management of intrapartum and postpartum care;
• Creating delivery plans and coordinating care during delivery and in the peripartum period;
• Titrating and optimizing medication;
• Providing patient counseling and education; and
• Transitioning patients postpartum to primary care or ongoing cardiac care.

Postpartum Period and Fourth Trimester: Closing the Highest-Risk Gap

The postpartum period carries the highest risk of adverse CV events, yet it is also the phase during which care is most vulnerable to fragmentation.^6-8

The presented case illustrates how APP-led follow-up enabled early recognition of postpartum hypertension and pre-eclampsia complications, facilitated rapid re-engagement with cardiology care, and supported discharge planning and transition to outpatient monitoring.

APPs are especially effective in this phase due to their abilities to:

• Expand access to care through innovative care models such as telehealth, shared clinics with OB, MFM or primary care, or mobile clinics;
• Conduct frequent touchpoints;
• Manage remote monitoring programs;
• Reinforce education and adherence;
• Titrate and optimize medical therapy;
• Screen for emotional and mood well-being, as well as provide first-line therapies and interventions;
• Prescribe and implement appropriate contraception; and
• Bridge transitions to primary care and long-term CV care.

This case reinforces that APPs are valuable and essential partners in cardio-obstetric care delivery. Through early risk identification, coordinated multidisciplinary management, and proactive postpartum follow-up, APP-integrated models improve outcomes and reduce care gaps. As CVD in pregnant patients continues to rise, scaling team-based, APP-driven care models will be critical to improving survival, advancing equity, and delivering truly longitudinal CV care for women.

References

1. Holmes D, Bartra S, Nadeau C, Phillipi J, Rasmusson K, Gonzalez-Valez J, Bello N. Strengthening Pregnancy Outcomes Utilizing Advanced Practice Providers in Cardio-Obstetric Care: A Case Report. Presented at 10th International Congress on Cardiac Problems in Pregnancy (CPP 2026), Barcelona, Spain. April 18, 2026.
2. Davis MB, Arendt K, Bello NA, et al. Team-based care of women with cardiovascular disease from pre-conception through pregnancy and postpartum: JACC focus seminar 1/5. J Am Coll Cardiol. 2021;77(14):1763-1777. doi:10.1016/j.jacc.2021.02.033
3. Bello NA, Agrawal A, Davis MB, et al. Need for better and broader training in cardio-obstetrics: a national survey of cardiologists, cardiovascular team members, and cardiology fellows in training. J Am Heart Assoc. 2022;11(8):e024229. doi:10.1161/JAHA.121.024229
4. Wolfe DS, Guerrero K. The contemporary cardio-obstetrics team: the path to improving maternal outcomes in high-risk patients. Am Heart J. 2025;281:140-148. doi:10.1016/j.ahj.2024.12.001
5. Iqbal T, Crooks T. Cardio-Obstetrics Essentials: Advancing Care For Women's Heart Health (ACC website). 2025. Available at: https://www.acc.org/latest-in-cardiology/articles/2025/12/01/01/feature-cardio-obstetrics-essentials. Accessed 08/27/2026.
6. Tamirisa KP, Oliveros E, Morse N, Hayes SN. Framework to transform reproductive age women's cardiovascular care. JACC Adv. 2026;5(6 Pt 1):102736. doi:10.1016/j.jacadv.2026.102736
7. Lindley KJ, Bello NA, Berlacher KL, et al. Optimization of postpartum care for patients with and at risk for premature and long-term cardiovascular disease: 2026 ACC expert consensus decision pathway: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published online May 22, 2026. doi:10.1016/j.jacc.2025.11.001
8. Lewey J, Beckie TM, Brown HL, et al. Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: a scientific statement from the American Heart Association. Circulation. 2024;149(7):e330-e346. doi:10.1161/CIR.0000000000001212