The goal of this clinical trial is to learn whether HEART at Home (Home-based Engagement And Remote Treatment for Hypertension), a home-based postpartum hypertension care program, is feasible and acceptable for people with high blood pressure after delivery and the health care teams caring for them. The main questions it aims to answer are: Is HEART at Home feasible to deliver, including successful enrollment, completion of home visits and blood pressure monitoring, and delivery of the planned intervention? Is HEART at Home acceptable to participants and health care providers? The study will also explore changes in blood pressure control and track emergency room visits and hospital readmissions related to high blood pressure. Participants will: Measure their blood pressure at home using a provided blood pressure cuff and securely share their readings with the health care team. Receive home visits and phone or text check-ins from trained postpartum doulas for the first three months after delivery. Doulas will provide education, assist with blood pressure monitoring, and help participants connect with ongoing medical care. Have their blood pressure readings reviewed by nurses and doctors, who may adjust blood pressure medications as needed. At 12 weeks after delivery, a plan set for ongoing care with a primary care provider or heart specialist.
High blood pressure during and after pregnancy can put people at risk for serious health problems after delivery. Many patients do not receive enough follow-up care once they leave the hospital, and high blood pressure can continue or worsen in the weeks after childbirth. This study will test whether a new care approach is practical and acceptable for patients and health care teams. The study combines home blood pressure monitoring, home visits by trained postpartum doulas, and telehealth visits with medical providers during the first three months after delivery. This novel intervention is called HEART at Home (Home-based Engagement And Remote Treatment for Hypertension). People who recently gave birth and have ongoing high blood pressure will be invited to join the study. Participants will measure their blood pressure at home using a provided cuff and share their readings through a secure mobile system. Nurses and doctors will review these readings and adjust blood pressure medications when needed. Participants will also receive home visits and phone or text check-ins from trained postpartum doulas, who will provide education, help with blood pressure measurement, and support in connecting to ongoing medical care. At about 12 weeks after delivery, participants will have planning for future care with a primary care provider or heart specialist. The study will collect information about how easy the program is to carry out, how often participants complete visits, and how helpful participants and providers find the program. The study will also track blood pressure control and any emergency room visits or hospital readmissions related to blood pressure. This information will be used to improve postpartum care for people with high blood pressure in the future.
Study Type
OBSERVATIONAL
Enrollment
10
The intervention integrates biweekly home visitor-led BP monitoring and health education, extended rBPM through 12 weeks, protocol-driven escalation to the clinical team, and clinician-supervised medication management and telehealth follow-up. Core components of HEART at Home include: 1) home visiting-based BP measurement and support for patient-initiated rBPM between visits, 2) cardiovascular risk assessment and patient education, 3) protocolized clinical escalation and pharmacologic management, and 4) facilitated linkage to longitudinal clinical care.
Barnes Jewish Hospital
St Louis, Missouri, United States
Adoption
Completion of \>=1 home visit with blood pressure measurement and transmission to clinical team
Time frame: continuous across 12 weeks
Reduction in Systolic BP
Reduction in Systolic BP
Time frame: 6 and 12 weeks postpartum
Reduction in Diastolic Blood Pressure
Reduction in Diastolic Blood Pressure
Time frame: 6 weeks and 12 weeks postpartum
Number of Blood-Pressure Lowering Medication Changes
Any initiation, discontinuation, dose change, or change in antihypertensive medication during weeks 2-12 postpartum.
Time frame: Continuous, 2-12 weeks postpartum
Blood pressure Control
Proportion of patients with BP \<130/80 mm Hg
Time frame: 6 and 12 weeks postpartum
Fidelity
Completion of three scheduled in-person home visits, participation in remote BP monitoring during the intervention period with appropriate escalation of abnormal BP or symptoms
Time frame: continuous, 2-12 weeks postpartum
Reach
Recruitment rate over study enrollment period
Time frame: Baseline (3-5 days postpartum)
Time-Based Cost
number of additional minutes needed to deliver HEART at Home components at each home visit
Time frame: continuous, 2-12 weeks
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