摘要
背景：在美国，妊娠高血压疾病（HDP）是导致孕产妇发病和死亡的主要原因之一，而且会增加再次入院和患心血管疾病的风险。美国妇产科医师学会建议患有严重妊娠高血压的妇女在分娩后出院 72 小时内进行随访。本研究旨在评估产后高血压（PPHTN）门诊是否能改善随访和管理：方法：对康涅狄格州哈特福德市一家单中心三级医院的转诊队列进行回顾性病历审查。研究对象包括 2022 年 3 月至 2023 年 2 月期间转诊至 PPHTN 诊所的重度 HDP 妇女。研究的主要结果是出院后 72 小时内就诊的患者比例、达到目标血压（BP）的患者比例（结果）：我们的队列中有 157 名女性，平均年龄为 32 岁（19-44 岁），平均体重指数 (BMI) 为 32 kg/m2（16-49），白人占 39%，非裔美国人占 24%，西班牙裔占 33%。合并症包括 41% 的非妊娠、19% 的妊娠糖尿病、23% 的高血压、28% 的妊娠高血压和 10% 的先兆子痫。在门诊就诊的妇女中，53%在72小时内接受了观察，28%在首次就诊时达到了血压目标，58%在随后的就诊中达到了血压目标。5%的妇女再次入院。总体而言，86% 的人接受了 HDP 教育，89% 的人在出院时配备了血压袖带。最后，85%的患者出院时服用了降压药，60%的患者产后需要调整降压药：我们的举措大大提高了在出院 72 小时内对患者进行观察的比例，并促进了纵向随访。今后需要进行分析，以评估再入院率的降低情况和 PPHTN 诊所的成本效益。Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality in the United States with an increased risk for hospital readmission and cardiovascular disease. The American College of Obstetricians and Gynecologists recommends that women with severe HDP follow-up within 72-hours post-discharge after childbirth. The purpose of this study is to evaluate if a postpartum hypertension (PPHTN) clinic improves follow-up and management.
Methods: Retrospective chart review of a referred cohort in a single-center, tertiary care hospital in Hartford, Connecticut. This study included women with severe HDP who were referred to the PPHTN clinic between March 2022 to February 2023. Primary outcomes were the percentage of patients seen within 72-hours postdischarge of hospitalization, percentage of patients achieving goal blood pressure (BP) (<130/80) at first and last follow-up visits, and hospital readmission rate. Secondary outcomes included the percentage of patients receiving HDP education materials, automatic BP cuff upon discharge from hospitalization, and antihypertensive medications prescribed postpartum.
Results: Our cohort had 157 women with a mean age of 32 years old (19-44), mean body mass index (BMI) 32 kg/m2 (16-49), and were 39% White, 24% African American, and 33% Hispanic. Comorbidities included 41% nulliparity, 19% gestational diabetes, 23% HTN, 28% gestational HTN and 10% prior preeclampsia. Among the women seen in the clinic, 53% were observed within 72 hours, 28% achieved their goal BP at first visit, and 58% achieved their goal BP at subsequent visits. Hospital readmission occurred in 5% of women. Overall, 86% received HDP education and 89% had or were prescribed a BP cuff upon discharge. Lastly, 85% were discharged on antihypertensives and 60% required antihypertensive modification postpartum.
Conclusion: Our initiative significantly improved the percentage of patients observed within 72 hours of discharge and facilitated longitudinal follow-up. Future analysis is needed to evaluate readmission rate reduction and the cost-effectiveness of the PPHTN clinic.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
