Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI, United States.
Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI, United States.
Pregnancy Hypertens. 2023 Dec;34:1-4. doi: 10.1016/j.preghy.2023.09.002. Epub 2023 Sep 9.
To evaluate provider adherence to aspirin prophylaxis prescription guidelines for patients at risk.
A retrospective chart review was performed at Henry Ford Health (HFH) between October 2015 and December 2020. In October 2015, low-dose aspirin was recommended for women who met high risk criteria for preeclampsia at HFH; in February 2019, aspirin recommendation expanded to include women who met either moderate or high-risk criteria. A total of 46,016 pregnancies occurred between Oct 2015 and Dec 2020 of which 15,167 (33.0%) met high and moderate risk criteria.
From the population at risk, 1,255 (8.3%) had a history of preeclampsia, 2,534 (16.7%) had a history of chronic hypertension, 1,418 (9.3%) had a history of diabetes, 7,470 (49.3%) were nulliparous, 4,038 (26.6%) were 35 years of age or older, 6,395 (42.2%) had a body mass index greater than 30 kg/m2, and 8,174 (54.5%) were African Americans. Only 630 out of 3,584 (17.6%) of women meeting the high-risk criteria for preeclampsia between Oct 2015 and Jan 2019 received low-dose aspirin and only 891 out of 5,874 (15.2%) of women meeting the high or moderate risk criteria for preeclampsia between Feb 2019 and Dec 2020 received low-dose aspirin prophylaxis.
Adherence to aspirin prophylaxis guidelines was low. Most urban healthcare systems serve diverse, high-risk populations with multiple comorbidities rendering many women at risk for preeclampsia. Educational efforts to improve provider knowledge regarding this important preventative measure are indicated. Recommendation for implementing universal aspirin in such high-risk populations should also be considered.
评估提供者对有风险的患者阿司匹林预防治疗处方指南的遵循情况。
2015 年 10 月至 2020 年 12 月，在亨利福特健康系统（HFH）进行了回顾性图表审查。2015 年 10 月，HFH 建议对有子痫前期高危标准的女性使用低剂量阿司匹林；2019 年 2 月，阿司匹林的推荐扩展到包括有中危或高危标准的女性。在 2015 年 10 月至 2020 年 12 月期间，共有 46016 例妊娠，其中 15167 例（33.0%）符合高危和中危标准。
在高危人群中，有 1255 例（8.3%）有子痫前期病史，2534 例（16.7%）有慢性高血压病史，1418 例（9.3%）有糖尿病病史，7470 例（49.3%）为初产妇，4038 例（26.6%）年龄在 35 岁或以上，6395 例（42.2%）体重指数大于 30kg/m2，8174 例（54.5%）为非裔美国人。在 2015 年 10 月至 2019 年 1 月期间，有 3584 例符合子痫前期高危标准的女性中，仅有 630 例（17.6%）接受了低剂量阿司匹林治疗，在 2019 年 2 月至 2020 年 12 月期间，有 5874 例符合子痫前期高危或中危标准的女性中，仅有 891 例（15.2%）接受了低剂量阿司匹林预防治疗。
阿司匹林预防治疗指南的遵循情况较低。大多数城市医疗系统服务于多种高危人群，这些人群存在多种合并症，使许多女性面临子痫前期的风险。需要开展教育活动，提高提供者对这一重要预防措施的认识。还应考虑在这些高危人群中推荐使用普遍的阿司匹林。
