Abstract
Objective
Hypertensive disorders of pregnancy (HDP) are associated with increased risk for future cardiovascular disease. Guidelines recommend longitudinal follow-up for cardiovascular risk stratification after pregnancy complicated by HDP; however, adherence to this recommendation remains suboptimal. Our aim was to evaluate the impact of the Postpartum Hypertension Program (PHP), a quality improvement initiative designed to address patient, clinician, and system barriers to longitudinal follow-up after HDP.
Methods
This was a retrospective cohort study evaluating rates of longitudinal follow-up before and after PHP implementation at a level IV maternal care center. Individuals were eligible if they had a diagnosis of HDP and were discharged on antihypertensive medication after delivery. A post-implementation cohort (eligible individuals referred to the PHP with delivery discharge from January 21, 2024 to March 22, 2025) was compared to a pre-implementation cohort (all eligible individuals with delivery discharge from January 1, 2021 to January 20, 2024). The primary outcome was follow-up with a longitudinal clinician (Cardiology, Internal Medicine, or Family Medicine) within 1 year postpartum. Secondary outcomes included rates of longitudinal follow-up at 3 and 6 months postpartum and patient characteristics associated with 1-year follow-up. Program components included: (1) clinician education, (2) patient education, and (3) a streamlined process for transfer-of-care to a longitudinal clinician. Data were abstracted from the medical record. Bivariate analysis compared outcomes between cohorts, and multivariable logistic regression was used to adjust for potential confounders.
Results
A total of 227 individuals met inclusion criteria (pre-implementation: n = 145, post-implementation: n = 82). PHP implementation was associated with increased longitudinal follow-up within 1 year postpartum (60.7% vs. 76.8%, p = 0.013). Follow-up rates in the post-implementation cohort were also higher at 3 months (31.7% vs. 62.2%, p < 0.001) and 6 months postpartum (49.0% vs. 72.0%, p = 0.001) compared to the pre-implementation cohort. Individuals who had a longitudinal visit within 1 year were more likely to have medical comorbidities compared to those who were not seen within 1 year. After adjusting for confounders, PHP implementation remained independently associated with increased follow-up within 1 year (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 1.3–4.7; p = 0.008).
Conclusion
PHP implementation was associated with 2.6-fold increased odds of longitudinal follow-up within 1 year after pregnancy complicated by HDP. With adequate infrastructure and resources, this program can serve as a model for institutions seeking to improve longitudinal care transitions for individuals with HDP. Further study is needed to determine the impact of improved follow-up rates on long-term cardiovascular health