Nearly 20% of postpartum patients in the US have high blood pressure; Epic Research has just been found in a New research shows that postpartum hypertension nearly triples the chance of being readmitted to the hospital.
After looking at more than 1.2 million births, then grouping and comparing peak blood pressure readings taken 24 hours after discharge, the study found:
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Patients with blood pressure levels equal to or higher than 160/110 immediately before discharge were nearly three times more likely to be readmitted to the hospital than patients with normal blood pressure readings.
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More than 5% of postpartum patients with the highest BP reading, equal to or greater than 160/110 mmHg, were readmitted.
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These data suggest a strong relationship between postpartum BP control and re-hospitalization in the postpartum period.
Dr. Christopher Alban is a physician and clinical informatics at EHR provider Epic in Verona, Wisconsin. He is the lead author of the study. Dr. Kelly Gibson is director of the division of maternal and fetal medicine at MetroHealth in Cleveland, Ohio.
Healthcare IT News sat down with the two of them to discuss research and the role healthcare information technology plays in helping to solve the problem.
Q. Please tell me the results of your research on postpartum hypertension and re-hospitalization.
gibson: Preeclampsia and other hypertensive disorders of pregnancy are common and one of the leading causes of maternal morbidity and mortality. While much of the attention to early detection and treatment of this disorder is focused on the pre- and perinatal period, a significant proportion of cases occur postpartum in the postpartum period.
During the week postpartum, about half of patients will develop persistent hypertension and 2-5% will be readmitted to the hospital for further treatment.
However, the relationship between postpartum BP control and rehospitalization is unclear. Because this complication, although one of the leading causes of postpartum re-hospitalization, is relatively rare, we needed a large dataset to conduct this study.
“The findings suggest that by treating blood pressure at a lower target level, some re-hospitalization could be prevented.”
Dr. Kelly Gibson, MetroHealth
Having a large pool of patient data gives us enough statistical power to review rare outcomes and make recommendations. The Epic Cosmos dataset contains millions of records linked between birth parents and infants, making it a rich resource for obstetric research.
In our study, we found that postpartum patients with lower blood pressure at discharge had a lower rate of re-hospitalization than those discharged with high blood pressure. This suggests that improved blood pressure control after delivery can reduce maternal morbidity and mortality in the postpartum period. Further prospective studies are needed to determine the best course and duration of treatment.
Q. Do you think postpartum care should be continued after giving birth? Why, based on your findings, do you believe this?
gibson: The physiological changes of pregnancy occur during the nine months of pregnancy, and they do not end immediately with the birth of the baby and the placenta. These changes in the pregnant patient’s body, as well as the physical and emotional toll of childbirth, persist for many months after birth.
One of those changes is the impact on the cardiovascular system and blood pressure. For 5-10% patients, their blood pressure will increase during pregnancy due to gestational hypertension or preeclampsia.
We know that preeclampsia increases a patient’s short-term risk of re-hospitalization as well as the long-term risk of cardiovascular disease. Therefore, treatment and follow-up of these patients is essential to promote the long-term health of new parents.
When I started exercising, I often told my patients that “birth is the way to treat preeclampsia” and focused less on blood pressure after discharge. We understand now that childbirth is part of the cure for the disease, but the illness will last. Appropriate monitoring and treatment can reduce a patient’s risk of re-hospitalization, morbidity, and even death after birth.
Current recommendations are to check blood pressure after discharge and educate patients on “Postpartum Warning Signs”. What the target blood pressure should be or whether hospital blood pressure values are related to short- and long-term outcomes remains unclear.
Our hypothesis is that higher blood pressure in the hospital translates to higher values at home and increases the risk of re-hospitalization and morbidity. With this study, we were able to show a strong correlation between blood pressure and readmission, and we are currently using this to advise tighter control of maternal blood pressure prior to discharge.
Q. How does monitoring a patient’s blood pressure after delivery reduce the likelihood of the patient being hospitalized again?
gibson: One of the most common reasons for re-hospitalization after delivery is high blood pressure. These readmissions are essential to the patient’s well-being after birth, but they can be upsetting for a new family at home. Re-hospitalization can lead to short-term separation between parent and baby, affect breastfeeding success, and increase stress and anxiety.
Our study showed a relationship between hypertension and rehospitalization. The findings suggest that by treating blood pressure at a lower target level, some readmissions may be prevented.
We can use this data to support further research into the best treatment regimen and blood pressure goals. With improved blood pressure control, obstetric care providers can help improve maternal outcomes, keep new parents healthier, and stay at home with their newborns. surname.
Q. What is the role of healthcare information technology in all of this?
Alban: As Kelly mentioned earlier, identifying patterns around an infrequently occurring clinical condition can be challenging without large clinical data sets. This is where Cosmos, Epic’s massive EHR data analytics platform, comes into play.
As the number of organizations using Epic has increased over the past few years, it has become clear that we have the opportunity to create a new database, focused on health research, unlike any other. existing.
Cosmos combines billions of clinical data points in a way that forms an integrated, representative, unmatched, and high-quality dataset that can be used to transform the health and lives of people everywhere. place.
As of January 2023, Cosmos contains records from 190 organizations, including 176 million patients and 6.3 billion encounters. Crucial to this study was the ability to link data between infants and their biological parents.
Since Epic Research’s first published summary at the start of the COVID-19 pandemic, we’ve been working on clinical questions to help make quick decisions about medications and treatment options.
And perhaps most importantly, the Cosmos database is available to all participating organizations. This study is a great example of a collaborative approach between Kelly, an obstetrician at MetroHealth, and me, a physician researcher at Epic.
This collaborative approach has also been used by Epic Research with the US Food and Drug Administration, the US Department of Health and Human Services, the CDC and the Kaiser Family Foundation, among others, and we continue to look for opportunities to collaborate with Cosmos Participating Organizations in the future.
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