(975) One Year Postpartum Follow-Up after Diagnosis of Hypertensive Disorder of Pregnancy (HDP)

A recent study at an urban tertiary care center illustrated that implementing a hospital-wide quality improvement bundle for postpartum (PP) patients with HDP improved six-week postpartum visit compliance and blood pressure control. This study examined the effect of this PP quality improvement initiative on long-term outcomes.

Study Design: Data were collected retrospectively from a University of Chicago (UCM) cohort of 1480 patients between October 2018 and June 2020. Patients were enrolled in the Systematic Treatment and Management of Postpartum Hypertension Program (STAMPP). Patients received blood pressure cuffs, standardized education, and follow-up. At the 6-week postpartum follow-up, patients received instructions for primary care (PCP) or cardiology follow-up. Data were then collected on this follow-up, blood pressures, and lipid values for 12 months after delivery.

Results:

A total of 939 (63%) patients had some follow-up within twelve months, of which 113 (12%) and 146 (16%) had follow-up with cardiology and primary care providers, respectively. Patients with no follow-up were more likely to have public aid (73.9% vs 60.3%; p< 0.001) and present as transfers (7.5% vs 4.5%; p=0.02). Of the 939 who followed up, 730 (78%) identified as African American with only 12% of this cohort following up with cardiology and 13% with a PCP. There was no difference in median cholesterol levels amongst patients with cardiology vs PCP follow-up (180 vs 164, p=0.28).  Systolic blood pressures were higher in patients who followed up with the cardiologist as compared to those who followed up with a PCP (median 134 [IQR 125, 147] vs 128 [118, 139] mmHg; p=0.001).

Conclusion: Amongst high-risk women with HDP, we found that despite specific instructions for follow-up with PCP or cardiology, only a minority of patients had follow-up. Further work is needed to identify barriers faced by PP women to seek appropriate care and optimize long-term cardiology and PCP follow-up after a diagnosis of HDP, especially amongst women of color.