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Cosmos Study - Collaboration

High Blood Pressure After Childbirth Nearly Triples Risk of Readmission

December 20, 2022
Dual-Team Study
Team A:Kelly Gibson, MDJoey HaddockGrant Keane
Team B:Christopher Alban, MDTim KeoghNatasha Joseph

Key Findings 

  • Higher inpatient postpartum blood pressure readings correlate with higher readmission rates for postpartum patients after discharge. Patients with blood pressure levels at or above 160/110 shortly before discharge are nearly three times more likely to be readmitted than patients with normal blood pressure readings. 

Recommended Actions 

  • Healthcare providers should actively manage blood pressures for postpartum patients after discharge. 
  • Healthcare organizations should use postpartum programs, such as home monitoring programs, to reduce the risk of postpartum readmissions. 

Postpartum hypertension is a major reason for postpartum readmission in the United States1. Previous studies have found evidence that a postpartum patient’s maximum blood pressure reading during the labor and delivery admission can help predict the likelihood of readmission2. 

To further understand the relationship between postpartum blood pressure control at discharge and its influence on readmission rates within the first six weeks after delivery, we looked at more than 1.2 million birth encounters and grouped patients into categories based on the highest blood pressure reading taken in the 24 hours prior to their discharge. We then compared the readmission rates across these groups. 

Figure 1
Higher Blood Pressures Correlated with Increased Readmission Rates
Higher Blood Pressures Correlated with Increased Readmission Rates
Figure 1. Readmission rates within six weeks of delivery by highest blood pressure reading for the patient. Patients were grouped by the highest postpartum blood pressure reading within 24 hours prior to discharge.

In the first six weeks after delivery, readmission rates for all causes rose with increased blood pressure. More than 5% of postpartum patients with the highest blood pressure readings, equal to or greater than 160/110 mmHg, were readmitted. They were 2.8 times more likely to be readmitted than patients whose highest blood pressure reading during their birth admission fell into the normal range (systolic between 120 and 130 and diastolic below 80 mmHg). 

Our data suggest a close relationship between postpartum blood pressure control and readmission in the postpartum period. As nearly 20% of patients can develop postpartum hypertension3, providers should actively manage blood pressure for their postpartum patients to minimize risk of readmission. Our findings also highlight future opportunities to study postpartum hypertension treatment and home monitoring programs. 

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 173 million patients from 185 Epic organizations including 1,063 hospitals and more than 22,500 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. This study was done in collaboration with a physician from MetroHealth.

References

  1. DM Stamillo, AJ Beckman, KA Boggess, JE Jelovsek, KK Venkatesh. Risk factors for postpartum readmission for preeclampsia or hypertension before delivery discharge among low-risk women: a case-control study. Am J Obstet Gynecol MFM. 2021 Mar; 3(3);100317.doi: 10.1016/j.ajogmf.2021.100317. 
  2. N Mukhtarova, O Alagoz, YH Chen, K Hoppe. Evaluation of different blood pressure assessment strategies and cutoff values to predict postpartum hypertension-related readmissions: a retrospective cohort study. Am J Obstet Gynecol MFM. 2021 Jan;3(1):100252. doi: 10.1016/j.ajogmf.2020.100252. Epub 2020 Oct 6. PMID: 33451628.
  3. Goel A, Maski MR, Bajracharya S, et al. Epidemiology and Mechanisms of De Novo and Persistent Hypertension in the Postpartum Period. Circulation. 2015;132(18):1726-1733. doi:10.1161/CIRCULATIONAHA.115.015721