Optimizing longitudinal follow‐up after hypertensive disorders of pregnancy: A quality improvement initiative

Abstract Objective Hypertensive disorders of pregnancy (HDP) are associated with increased risk for future cardiovascular disease. Guidelines recommend longitudinal follow‐up for cardiovascular risk stratification after pregnancy complicated by HDP; however, adherence to this recommendation remains suboptimal. Our aim was to evaluate the impact of the Postpartum Hypertension Program (PHP), a quality improvement initiative designed to address patient, clinician, and system barriers to longitudinal follow‐up after HDP. Methods This was a retrospective cohort study evaluating rates of longitudinal follow‐up before and after PHP implementation at a level IV maternal care center. Individuals were eligible if they had a diagnosis of HDP and were discharged on antihypertensive medication after delivery. A post‐implementation cohort (eligible individuals referred to the PHP with delivery discharge from January 21, 2024 to March 22, 2025) was compared to a pre‐implementation cohort (all eligible individuals with delivery discharge from January 1, 2021 to January 20, 2024). The primary outcome was follow‐up with a longitudinal clinician (Cardiology, Internal Medicine, or Family Medicine) within 1 year postpartum. Secondary outcomes included rates of longitudinal follow‐up at 3 and 6 months postpartum and patient characteristics associated with 1‐year follow‐up. Program components included: (1) clinician education, (2) patient education, and (3) a streamlined process for transfer‐of‐care to a longitudinal clinician. Data were abstracted from the medical record. Bivariate analysis compared outcomes between cohorts, and multivariable logistic regression was used to adjust for potential confounders. Results A total of 227 individuals met inclusion criteria (pre‐implementation: n = 145, post‐implementation: n = 82). PHP implementation was associated with increased longitudinal follow‐up within 1 year postpartum (60.7% vs. 76.8%, p = 0.013). Follow‐up rates in the post‐implementation cohort were also higher at 3 months (31.7% vs. 62.2%, p < 0.001) and 6 months postpartum (49.0% vs. 72.0%, p = 0.001) compared to the pre‐implementation cohort. Individuals who had a longitudinal visit within 1 year were more likely to have medical comorbidities compared to those who were not seen within 1 year. After adjusting for confounders, PHP implementation remained independently associated with increased follow‐up within 1 year (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 1.3–4.7; p = 0.008). Conclusion PHP implementation was associated with 2.6‐fold increased odds of longitudinal follow‐up within 1 year after pregnancy complicated by HDP. With adequate infrastructure and resources, this program can serve as a model for institutions seeking to improve longitudinal care transitions for individuals with HDP. Further study is needed to determine the impact of improved follow‐up rates on long‐term cardiovascular health.