(572) Evaluation of implementation of an EMR-based screening tool for initiation of low-dose aspirin in pregnancy

Objective: Low-dose aspirin in pregnancy has been shown to decrease preeclampsia and history based screening has historically poor compliance. In 2021 USPSTF endorsed consideration of aspirin with even a single moderate risk factor. We aimed to assess implementation of a new EMR-based screening tool for aspirin, as well patient acceptance of aspirin in the presence of moderate or high risk factor(s) for preeclampsia.

Study Design: We performed a retrospective cohort study of patients presenting to obstetric intake visits after implementation of an EMR-based screening tool in 2022. Patients were offered low-dose aspirin in the presence of only one moderate risk factor and recommended aspirin with more than one moderate or at least one high risk factor. The number of patients screened for aspirin at the first prenatal visit was evaluated. The relationship between moderate versus high risk factors and patient acceptance of aspirin therapy was also assessed with logistic regression. Descriptive statistics were performed.

Results: Among 586 patients presenting to initial obstetric visits, 531 patients (90.6%) were screened for preeclampsia risk with the EMR-based screening tool. In our patient population, 558 (95.2%) had at least one moderate or high risk factor with 120 patients (20.5%) with a single moderate risk factor, 340 (58.0%) with more than one moderate risk factor, and 98 (16.7%) with high risk factor(s). Patient acceptance of aspirin with one moderate, more than one moderate, and high risk factor(s) was 65.2%, 77.4%, and 93.8%, respectively (p< 0.05, Figure).

Conclusion: Incorporation of an EMR-based tool during obstetric intake visits led to >90% compliance with screening for preeclampsia risk factors. Of importance, >95% of patients had at least one moderate risk factor posing further consideration of universal aspirin use. We saw increased patient acceptance of aspirin therapy with increasing risk of preeclampsia. Future directions include examining the relationship between this clinical tool and pregnancy outcomes, as well as cost effective analyses and randomized trials of universal aspirin use.