Cardiovascular disease (CVD) remains one of the leading causes of death in pregnant patients in the United States, with persistent and widening disparities across racial, socioeconomic, and geographic lines. Sessions at ACC.26 (American College of Cardiology [ACC] Annual Scientific Session 2026)—including "Breaking Barriers in Cardio-Obstetrics," "The Fourth Trimester," "Building a Postpartum Hypertension Clinic," "Health Equity Across the Lifespan," and "Equity in Action"—collectively highlighted a critical paradigm shift: moving from episodic, pregnancy-focused care to a longitudinal, equity-centered model of cardiovascular (CV) prevention and management that spans pregnancy, postpartum transition, and long-term follow-up. Adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, and preterm birth, serve as early indicators of future CVD, and appropriate CV risk screening and transition of care are necessary to reduce lifelong risk.

Bridging Gaps in CV Care for Pregnant Patients¹

The session "Breaking Barriers in Cardio-Obstetrics: Advancing Equity and Reducing Maternal Mortality in the U.S." underscored the multifactorial drivers of inequities in CV outcomes for pregnant patients. These inequities include delayed recognition of CVD, limited access to cardio-obstetric expertise, fragmented care delivery, and structural barriers such as transportation challenges, insurance instability, and gaps in care coordination. These inequities disproportionately affect Black women, rural populations, and individuals in underserved communities, contributing to preventable morbidity, delayed treatment, and excess mortality.

The Fourth Trimester: A Missed Opportunity for Prevention²

The session "The Fourth Trimester: Long-Term CV Risk Reduction After Pregnancy in Patients With Cardiac Disorders" reframed the postpartum period as a pivotal transition point for CV care rather than the end of pregnancy-related care. Despite improved recognition of this important transitional period, postpartum follow-up remains inconsistent, particularly among patients at high risk and from underserved communities, for whom barriers such as childcare, transportation, and insurance coverage limit care. Structured postpartum CV assessment and transition planning enable early detection of chronic hypertension, heart failure, arrhythmias, and other ongoing CV conditions while creating an opportunity to initiate preventive strategies and counsel on future CV risk.

Reconceptualizing the fourth trimester as a bridge to long-term CV care is essential. This reconceptualization includes intentional transitions to primary and cardiac care, incorporation of CV risk counseling, and longitudinal follow-up strategies that extend well beyond the traditional 6-week postpartum visit.

Postpartum Hypertension Clinics: A Scalable Solution³

The session "Building a Postpartum Hypertension Clinic: Blueprint For the CV Team" highlighted a pragmatic and scalable model to address hypertensive disorders, a leading contributor to morbidity and readmissions in pregnant patients.

Postpartum hypertension clinics leverage standardized clinical workflows and algorithms, remote monitoring, and team-based care to improve long-term blood pressure (BP) control and reduce disparities in follow-up. These models are particularly effective in reaching patients who face barriers to in-person care by helping reduce disparities in access, engagement, and continuity of postpartum follow-up.

Core components of successful programs include:

• Early identification and enrollment before hospital discharge;
• Remote BP monitoring integrated with telehealth workflows;
• Multidisciplinary team involvement for monitoring, patient education, and medication titration;
• Clear escalation pathways for abnormal BP readings; and
• Integration with primary care and community health systems for long-term management.

These clinics demonstrate how structured, protocol-driven care can improve outcomes while reducing inequities in access and engagement. ACC's Postpartum Hypertension Clinic Development Toolkit offers practical guidance for program development and implementation.

Equity Across the Lifespan: A Longitudinal Approach⁴

The session "Health Equity Across the Lifespan" reinforced that CV inequities begin before birth and accumulate over time. Social drivers of health, including food insecurity, environmental exposures, chronic stress, and limited access to preventive care, shape CV risk trajectories across the lifespan.

Pregnancy represents a critical intersection at which underlying CV risk becomes clinically apparent. However, addressing CV health for pregnant patients in isolation is insufficient. A lifespan approach is required, one that integrates prevention, community-based interventions, and cross-sector collaboration beyond the pregnancy and postpartum periods.

Strategies such as Food Is Medicine programs, integration of mental health services, and culturally tailored care delivery models are essential to addressing upstream drivers of CV risk and achieving sustainable improvements in outcomes.

Expanding Access Through Innovation: Telehealth, Mobile Care, and Community Partnerships⁵

The session "Equity in Action: Creating Sustainable Access to Specialty Cardiovascular Care in Rural and Large Geographic Regions" highlighted innovative care delivery models designed to overcome geographic and workforce limitations.

Telehealth, remote monitoring, and mobile medical units extend cardio-obstetric services beyond traditional care settings, bringing specialized care directly to underserved communities. These models are particularly impactful in rural regions and maternal care deserts, where access to both obstetric and CV specialists is limited.

Successful implementation requires:

• Understanding community demographics, needs, and existing resources;
• Building strong partnerships with local providers, community organizations, and public health systems;
• Designing flexible, adaptable care models rather than a one-size-fits-all approach; and
• Leveraging shared care models between specialty centers and local clinicians.

Critically, effective programs are built with communities, not for them. Engaging patients and community stakeholders in program design ensures that interventions are culturally relevant, accessible, and sustainable.

Although these innovations can improve access, important barriers remain, including digital literacy gaps, infrastructure limitations, and variable reimbursement. Overcoming these barriers will require system-level redesign, flexible care pathways, multidisciplinary teams, and durable partnerships beyond the walls of traditional health systems.

From Innovation to Implementation

Across these sessions, a unifying message emerged: Improving CV outcomes for pregnant patients requires not only innovative models of care but also disciplined, equity-focused implementation.

Successful programs are adaptable, scalable, and designed with the needs of underserved communities at the center. Data infrastructure and quality improvement frameworks are essential to measure impact and ensure accountability.

Future efforts should focus on:

• Standardizing postpartum CV care pathways;
• Expanding data systems to track outcomes and disparities;
• Integrating community-based and patient-centered care models; and
• Advocating for sustainable policy and reimbursement structures that support multidisciplinary care.

Conclusion

Reducing CV mortality in pregnant patients in the United States requires a comprehensive, equity-driven strategy that spans pregnancy, the fourth trimester, and long-term follow-up. ACC.26 sessions highlight actionable approaches—from postpartum hypertension clinics to telehealth-enabled and community-partnered models of care—that can be implemented now to narrow gaps in access and outcomes.

For the CV community, the charge is clear: Build systems that do not end at delivery, do not depend on geography, and do not leave patients at high risk behind.

References

1. Bond R, Economy KE, Eshtehardi P, panelists; Briller JE, Harrington C, co-chairs. Breaking Barriers in Cardio-Obstetrics: Advancing Equity and Reducing Maternal Mortality in the U.S. Presented at ACC.26 (American College of Cardiology Annual Scientific Session 2026), New Orleans, LA. March 28, 2026.
2. Eshtehardi P, Canobbio MM, Ferranti E, Bartra S, Nadeau C, panelists. The Fourth Trimester: Long-Term CV Risk Reduction After Pregnancy in Patients With Cardiac Disorders. Presented at ACC.26 (American College of Cardiology Annual Scientific Session 2026), New Orleans, LA. March 30, 2026.
3. Countouris M, Rasmusson K, Thomas A, Ferranti E, panelists; Bartra S, Nadeau C, co-chairs. Building a Postpartum Hypertension Clinic: Blueprint For the CV Team. Presented at ACC.26 (American College of Cardiology Annual Scientific Session 2026), New Orleans, LA. March 30, 2026.
4. Ansong AK, Wood MJ, Ilonze OJ, Patton JA, Aspry KE, panelists; Fletcher JM, Holmes D, co-moderators. Health Equity Across the Lifespan. Presented at ACC.26 (American College of Cardiology Annual Scientific Session 2026), New Orleans, LA. March 30, 2026.
5. Bartra S, Duvernoy CS, Holmes D, Varosy PD, panelists; Don CW, Cantey CM, co-chairs. Equity in Action: Creating Sustainable Access to Specialty Cardiovascular Care in Rural and Large Geographic Regions. Presented at ACC.26 (American College of Cardiology Annual Scientific Session 2026), New Orleans, LA. March 28, 2026.