Improving Cardiovascular Follow-Up after Diagnosis of a Hypertensive Disorder of Pregnancy using the Electronic Health Record

Abstract

Background: Cardiovascular disease is the leading cause of death among women. Sex-specific risk factors for cardiovascular disease include history of a hypertensive disorder of pregnancy. Problem: After diagnosis of a hypertensive disorder of pregnancy, professional societies recommend follow-up with a primary care provider for preventative care. There are gaps in patient and health care provider knowledge of the association between a hypertensive disorder of pregnancy and cardiovascular disease. That gap has a negative effect on patients receiving recommended follow-up. Methods: An electronic registry was created to identify those who gave birth in our health system and had a diagnosis of hypertensive disorder of pregnancy. From this, information outreach was sent electronically to the patient and their primary care provider. Interventions: Communication in the outreach included education on the association between hypertensive disorders of pregnancy and cardiovascular disease, the importance of follow-up, cardiopreventative strategies, and biochemical assessment. Medical records were audited at approximately 6 months postpartum to determine if patients completed a visit with their primary care provider to discuss cardiovascular risks. Results: Between May 2021 and June 2022, 15% (n = 1,131) of patients who gave birth in our health system had a diagnosis of hypertensive disorder of pregnancy. Ninety percent of those patients who received outreach communication viewed the letter. At baseline, 16% of patients during postpartum with a hypertensive disorder of pregnancy saw their primary care provider to discuss cardiopreventative strategies. After implementation of our program, 26% of those with a hypertensive disorder of pregnancy saw their primary care provider for follow-up and discussed cardiopreventative strategies. Clinical Implications: Nurses should ensure that women during postpartum and their primary care providers are educated about the association of hypertensive disorders of pregnancy and long-term cardiovascular risk. The electronic health record may be an optimal way to ensure education is provided and follow-up scheduled.

Cardiovascular Disease Risk Factor Interventions in Women With Prior Gestational Hypertensive Disorders or Diabetes in North America: A Rapid Review

“…Thus, 3240 papers were screened for title and abstract, 17 were screened at full text, and 8 met the inclusion criteria and are included in this review. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Figure 1 shows the flowchart of the included studies. Of the 8 studies, 4 were observational cohort studies, 18 , 19 , 20 , 21 ), 3 were RCTs, 15 , 16 , 17 and 1 was a quasi-experimental study.…”

“… 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Figure 1 shows the flowchart of the included studies. Of the 8 studies, 4 were observational cohort studies, 18 , 19 , 20 , 21 ), 3 were RCTs, 15 , 16 , 17 and 1 was a quasi-experimental study. 22 Studies were published between 2014 and 2023.…”

“…Of the 4 observational studies, 3 implemented a postpartum maternal health program, 19 , 20 , 21 and 1 used an electronic registry to identify women who had previous HDP, for postpartum follow-up. 18 Among the RCTs, only 1 was a multicentre study. 16 Details on the methodology, sample size, sampling, and analysis of the included observational and intervention studies are summarized in Tables 1 and 2 , respectively.…”

“…Among the observational studies, the number of participants ranged from 21 women 21 to 1131 women. 18 For the intervention studies, the number of participants ranged from 64 women in the smallest study 22 to 333 women in the largest study. 15 Overall, the age of participants ranged from 18 to 55 years.…”

“…Three of the observational studies implemented a CVD risk factor education intervention for postpartum women with a history of HDP or GDM. 18 , 19 , 21 In all 3 studies, letters were sent to the participants’ primary care provider (PCP) or obstetrical care provider (for women without a PCP), to explain the participants’ risks for premature CVD and to reinforce delivery of postpartum follow-up. In 1 study, participants also received numerous messages regarding CVD risk, through a personal electronic health record platform.…”