ACC Releases Pathway Optimizing Postpartum Care, Preventing Cardiovascular Risk

The American College of Cardiology (ACC) released a 2026 Expert Consensus Decision Pathway to optimize postpartum care for patients at risk for cardiovascular disease (CVD), identifying the first year after delivery as a critical window for intervention. With more than half of pregnancy-related deaths occurring after childbirth, particularly within the first 2 weeks, ACC emphasizes a multidisciplinary team-based approach that explicitly includes the expertise of pharmacists to navigate complex medication regimens and transitions of care.¹

“The postpartum period is a critical opportunity to engage in collaborative patient care that is focused on improving short- and long-term cardiometabolic outcomes,” Kathryn J. Lindley, MD, FACC, chair of the ECDP writing committee and associate professor of medicine at Vanderbilt University Medical Center’s Division of Cardiovascular Medicine, said in a news release.²

Pharmacists are tasked with vital medication reconciliation, as data shows nearly 10% of patients with chronic hypertension fail to resume necessary therapy following delivery. During this vulnerable window, patients experience significant hemodynamic shifts, including fluid mobilization that causes blood pressure to peak 5 to 7 days after birth and increases the risk of hemorrhagic stroke by more than 4-fold.¹

The pathway establishes clear targets for blood pressure management, recommending clinicians treat patients to below 140/90 mm Hg prior to hospital discharge and suggesting a more aggressive outpatient threshold of 130/80 mm Hg to align with nonpregnant adult standards and preserve long-term renal function. Pharmacists may also support remote blood pressure monitoring programs, which have been shown to reduce racial disparities in care and decrease the likelihood of hospital readmissions for worsening hypertension.¹

Clinical pharmacists must navigate the complexities of medication compatibility with lactation, utilizing resources like the Drugs and Lactation Database to ensure that most cardiovascular treatments are safe for breastfeeding individuals. First-line antihypertensives such as nifedipine XL, enalapril, and amlodipine are considered safe, as they maintain a relative infant dose of less than 10%, which is the standard threshold for safety in lactation.¹

For patients suffering from pregnancy-associated heart failure, ACC supports the use of beta-blockers like metoprolol and carvedilol, as well as angiotensin-converting enzyme inhibitors like captopril and enalapril, though it notes that loop diuretics may slightly reduce milk volume. Conversely, medications such as amiodarone, direct oral anticoagulants, and newer heart failure therapies like sodium glucose cotransporter 2 inhibitors and angiotensin II receptor blockers/neprilysin inhibitors currently lack robust safety data and are generally avoided in breastfeeding patients. The consensus also positions the postpartum period as a gateway opportunity for long-term cardiometabolic screening, urging a comprehensive evaluation of lipids and diabetes status within 12 weeks of birth for those who experienced adverse pregnancy outcomes.¹

Pharmacists should play a lead role in the reinitiation of statin therapy once breastfeeding is complete for patients identified as having high atherosclerotic CVD risk. Furthermore, the pathway addresses reproductive health by advocating for the use of progestin-only pills as a safe contraceptive bridge for all cardiovascular conditions during the postpartum and breastfeeding periods.¹

To prevent patients from falling through the gaps of a fragmented health care system, the ACC recommends that the first outpatient follow-up occur within 7 to 10 days of delivery to monitor symptoms and adjust medications. The overarching goal of this structured approach is to transition patients from acute obstetric monitoring to longitudinal primary or cardiovascular care before the end of the first year.¹

Ultimately, this 2026 pathway serves as a call to action for the entire medical community to recognize that postpartum care is not merely the end of a pregnancy but the beginning of a lifelong commitment to cardiovascular health and equity.¹

“Understanding and following a structured approach to the provision of postpartum care for all individuals with or at risk for CVD is a crucial first step toward eliminating excess maternal morbidity and mortality and reducing inequities,” Lindley said.²

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REFERENCES

1. 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

2. American College of Cardiology issues decision pathway for postpartum cardiovascular care. News release. American College of Cardiology. May 22, 2o26. Accessed May 27, 2026. https://www.eurekalert.org/news-releases/1129265