Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension

Hoppe, Kara K.; Zernick, Melissa; Zella, Julia B.; Havighurst, Thomas C.; Kim, KyungMann; Williams, Makeba; Niu, Brenda; Lohr, Ali N.; Johnson, Heather M.

doi:10.1016/j.ajog.2020.05.027

Cited by 45 publications

(57 citation statements)

References 5 publications

(4 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We conducted a single-site non-randomized controlled trial of telehealth with remote monitoring and linked interventions for management of postpartum hypertension. The intervention was associated with reduced hospital readmissions compared to standard care (1 [0.5%] vs. 8 [3.7%], adjusted relative risk 0.12; 95% confidence interval (CI): 0.01–0.96) [ 9 ]. After providing informed consent, postpartum women prior to hospital discharge were assigned to and dispensed a remote monitoring unit that securely transmitted individual data to a central monitoring platform via Bluetooth technology leveraged by Honeywell (now Resideo) Lifestream Clinical Monitoring solution.…”

Section: Introductionmentioning

confidence: 99%

Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum

Drewry

Passmore

Assad

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Our aim was to conduct a post participation survey of respondent experiences with in-home remote patient monitoring via telehealth for blood pressure monitoring of women with postpartum hypertension. We hypothesized that the in-home remote patient monitoring application will be implemented with strong fidelity and have positive patient acceptability. Methods This analysis was a planned secondary analysis of a non-randomized controlled trial of telehealth with remote blood pressure patient monitoring for postpartum hypertension compared to standard outpatient monitoring in women with a hypertension-related diagnosis during pregnancy. In collaboration with survey experts, we developed a 41-item web-based survey to assess 1) perception of quality of care received, 2) ease of use/ease to learn the telehealth program, 3) effective orientation of equipment, 4) level of perceived security/privacy utilizing telehealth and 5) problems encountered. The survey included multiple question formats including Likert scale responses, dichotomous Yes/No responses, and free text. We performed a descriptive analysis on all responses and then performed regression analysis on a subset of questions most relevant to the domains of interest. The qualitative data collected through open ended responses was analyzed to determine relevant categories. Intervention participants who completed the study received the survey at the 6-week study endpoint. Results Sixty six percent of respondents completed the survey. The majority of women found the technology fit easily into their lifestyle. Privacy concerns were minimal and factors that influenced this included age, BMI, marital status, and readmissions. 95% of women preferred remote care for postpartum follow-up, in which hypertensive type, medication use and ethnicity were found to be significant factors in influencing location of follow-up. Most women were satisfied with the devices, but rates varied by hypertensive type, infant discharge rates and BMI. Conclusions Postpartum women perceived the telehealth remote intervention was a safe, easy to use method that represented an acceptable burden of care and an overall satisfying method for postpartum blood pressure monitoring. Trial registration ClinicalTrials.gov identification number: NCT03111095 Date of registration: April 12, 2017.

show abstract

Section: Introductionmentioning

confidence: 99%

Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum

Drewry

Passmore

Assad

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…25 The objective of the parent study was to evaluate whether remote blood pressure monitoring with daily blood pressure monitoring and an outpatient treatment algorithm reduced postpartum readmissions for elevated blood pressures. 23 Neither weight nor weight-related messages were part of parent study's intervention; however, daily weights were obtained using the Bluetooth-enabled scale. The purpose of daily weights in the parent study examining remote blood pressure monitoring was to assess for weight gain as evidence of fluid retention.…”

Section: Methodsmentioning

confidence: 99%

Does Daily Self-Weighing Contribute to Postpartum Weight Loss? A Secondary Analysis of Daily Postpartum Weights among Women with Hypertensive Disorders of Pregnancy

et al. 2021

View full text Add to dashboard Cite

Objective This study was aimed to examine the impact of daily self-weighing via remote monitoring on postpartum weight loss. Study Design This was a secondary analysis of a nonrandomized controlled trial comprised of postpartum women with diagnosed hypertensive-related disorders in pregnancy who received a tablet device linked to Bluetooth-enabled equipment including a scale and blood pressure cuff. In addition to blood pressure monitoring, participants were instructed to perform daily self-weighing. The primary outcome of this study was to determine whether postpartum women who performed daily self-weighing lost more weight than those who did not, with a 42-day endpoint based on a 6-week postpartum visit weight. Results Overall, 214 women participated in this program and 214 received usual care. Median weight loss for women participating in the remote blood pressure monitoring system was 23.0 (interquartile range [IQR]: 17–30) pounds versus 23.0 (IQR: 17–29) pounds among controls. Weight loss did not vary by prepregnancy obesity (median: 20 pounds [IQR: 17–28 pounds] for nonobese and 23 [IQR: 17–30] pounds for women with obesity, p = 0.16). Women who weighed themselves more than half of follow-up days lost a median of 24 pounds (IQR: 17–30 pounds) compared with 20.5 pounds (IQR: 14–29 pounds), p = 0.06. Women who weighed themselves more than half of follow-up days lost a mean of 11.4% (standard deviation [SD] = 0.41%) of body weight compared with 9.1% (SD = 0.74%; p = 0.01). The amount of weight loss in the telehealth group was correlated with the number of daily weights performed (Pearson's correlation coefficient 0.164, p = 0.025). Postpartum weight loss for daily self-weighing participants was most notable in the first 2 weeks with ongoing weight loss up to the 42-day (6-week) endpoint of this secondary analysis. Conclusion Daily self-weighing alone may be insufficient to promote postpartum weight loss. However, there was a slight trend toward more weight loss with more frequent weighing. Key Points

show abstract

“…In the postpartum period, remote blood pressure monitoring holds significant promise for improving rapid diagnosis and effective, low-cost intervention (Table 2 ). Use of remote blood pressure monitoring increases engagement with postpartum care and reduces racial disparities in postpartum blood pressure ascertainment [ 57 , 58 ••, 59 ]. Essential aspects of ensuring an efficacious intervention include (1) utilization of a validated blood pressure cuff, and (2) patient education prior to discharge regarding critical parameters for communication or intervention.…”

Section: Paradigm Shifts In Management Of Postpartum Hypertensionmentioning

confidence: 99%

Best Practices for Managing Postpartum Hypertension

Kumar

Hirshberg

Srinivas

2022

Curr Obstet Gynecol Rep

View full text Add to dashboard Cite

Purpose of Review Patients remain at risk for persistent and de novo postpartum hypertension related to pregnancy. This review aims to summarize the current definitions, clinical practices, and novel systems innovations and therapies for postpartum hypertension. Recent Findings Recent changes to the definitions of hypertension outside of pregnancy have not yet impacted definitions or management of hypertensive disorders of pregnancy (HDP), though research examining the implications of these new definitions on risks of developing HDP and the resultant sequelae is ongoing. The administration of diuretics has been shown to reduce postpartum hypertension among women with HDP. Widespread implementation of telemedicine models and remote assessment of ambulatory blood pressures has increased data available on postpartum blood pressure trajectories, which may impact clinical management. Additionally, policy changes such as postpartum Medicaid extension and an increasing emphasis on building bridges to primary care in the postpartum period may improve long-term outcomes for women with postpartum hypertension. Prediction models utilizing machine learning are an area of ongoing research to assist with risk assessment in the postpartum period. Summary The clinical management of postpartum hypertension remains focused on blood pressure control and primary care transition for cardiovascular disease risk reduction. In recent years, systemic innovations have improved access through implementation of new care delivery models. However, the implications of changing definitions of hypertension outside of pregnancy, increased data assessing blood pressure trajectories in the postpartum period, and the creation of new risk prediction models utilizing machine learning remain areas of ongoing research.

show abstract

Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension

Cited by 45 publications

References 5 publications

Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum

Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum

Does Daily Self-Weighing Contribute to Postpartum Weight Loss? A Secondary Analysis of Daily Postpartum Weights among Women with Hypertensive Disorders of Pregnancy

Best Practices for Managing Postpartum Hypertension

Contact Info

Product

Resources

About