(235) Discharge with Furosemide and Emergency Department Visits for Hypertension-Related Care in Patients with Severe Preeclampsia

Preeclampsia with severe features (PEC-SF) contributes to maternal morbidity and mortality. Prior studies have shown that use of furosemide postpartum leads to a faster reduction in blood pressure (BP) in patients with hypertensive disorders of pregnancy. This study assessed whether prescribing postpartum furosemide to patients with PEC-SF would lead to a decrease in hypertension-related emergency department (ED) visits in our predominantly Black, Indigenous, and people of color population (BIPOC).

Study Design: This was a retrospective chart review of patients with PEC-SF who delivered July 1, 2020 - June 30, 2021. Institutional practice is to prescribe postpartum 20mg furosemide daily for five days to patients with PEC-SF. The primary outcome was ED visit for hypertension-related care within 12 weeks of delivery. Fisher’s exact and Mann-Whitney U tests, and Firth multivariable logistic regression were used. Race and ethnicity, maternal age, delivery mode, postpartum day of discharge, furosemide prescription at discharge, other anti-hypertensive medication prescription at discharge, and ownership of a blood pressure machine (BPM) were used in the model.

Results: Among 105 patients with PEC-SF, 54 (51.4%) self-identified as non-Hispanic Black and 47 (44.8%) as Hispanic. 74(70.5%) patients were prescribed furosemide, 63 (60.0%) were prescribed another BP medication, and 76(72.4%) had a BPM. 16(15.2%) patients presented to the ED. Of the patients prescribed furosemide, 5(6.8%) returned to the ED; of those not prescribed furosemide, 11(35.5%) returned (p< 0.001).  Furosemide prescription at discharge was a predictor of p</span>resentation to the ED (OR=0.11, 95% CI: 0.02-0.38). After adjusting for demographic and clinical factors, the odds of an ED visit were 89% lower in patients who were discharged with furosemide. 

Conclusion: Postpartum furosemide significantly decreased the odds of postpartum ED visits in patients with PEC-SF. Standardizing this regimen could decrease the need for ED visits, decrease patient morbidity and healthcare costs, while improving patient experience in a BIPOC community.