(42) Clinical Outcomes Following Remote Hypertension Monitoring Program for Postpartum Individuals with Hypertensive Disorders of Pregnancy

We sought to evaluate outcomes following implementation of a remote monitoring program for postpartum individuals with a hypertensive disorder of pregnancy (HDP).

Study Design: We evaluated the impact of engagement in a remote hypertension management program in a cohort of postpartum individuals with a HDP delivering from 1/2018 - 6/2023 at a single institution. We compared postpartum readmission, office visit within 6 weeks, BP measurement within 10 days, and postpartum initiation of antihypertensive medication among those who participated to controls who did not participate. Program participation was at the discretion of the care provider and patient. We performed multivariate logistic regression and conditional regression in a propensity score matched cohort. Adjustment variables were included in propensity score modeling likelihood of program participation. Propensity scores were assessed for even distribution by group and ensuring standardized bias < 10% after matching.

Results: We included 14,382 eligible individuals (6501 participants, 7881 controls). Program participants were more likely to be white, commercially insured, reside in a more disadvantaged neighborhood, have a higher BMI, have preeclampsia, and have higher prenatal and inpatient postpartum BPs. These factors were well-balanced after implementation of propensity score. Program participants had lower 6-week postpartum readmission rates, demonstrating 16 fewer readmissions for every 1000 individuals in the program [adjRD=-1.6 (-2.5, -0.80); aRR 0.77 (0.68, 0.88)]. For every 100 individuals in the program, 85 more had a BP recorded within 10 days [adjRD=85.9 (85.1, 86.8)] and 7 more were adherent with 6-week postpartum office visit [adjRD=7.9 (6.4, 9.5)]. Participants were 3-4 times more likely to initiate an antihypertensive medication postpartum [ajdRR=3.79 (3.42, 4.19)].

Conclusion: Participation in a postpartum remote BP monitoring program was associated with fewer postpartum hospital readmissions, higher attendance at postpartum visits, improved guideline adherence, and higher rates of antihypertensive use after implementation.