Cardiomyopathy and Adverse Cardiac Events in Pregnant Women | Journal Scan

Study Questions:

Are women who have a history of cardiomyopathy (CMP) at increased risk for cardiac events during childbirth?

Methods:

The Healthcare Cost and Utilization Project’s National Inpatient Sample was used for the present study. Of the 39,887,824 hospitalization discharges reported between 2006 and 2010, 5,361,287 pregnant women were admitted for childbirth. All records with missing data on race and insurance were excluded. Hospital admissions were screened for pregnant women with a diagnosis of CMP. CMP was grouped into hypertrophic, peripartum, and other. Clinical factors and maternal outcomes were compared in the women with CMP to a group of women with no CMP. The primary outcome of interest was major adverse clinical events defined as in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular events, or embolic events.

Results:

A total of 2,078 women with CMP (2.5% with hypertrophy CMP, 50% with peripartum CMP, and 45.5% with other CMP) were compared with 4,438,439 women without CMP. Women with CMP were older and more likely to have Medicaid insurance compared to women without CMP. Among all women in the cohort (CMP yes or no), having CMP increased the risk of adverse events significantly (odds ratio [OR], 90.25; 95% confidence interval [CI], 80.61-101.05). Rates of adverse outcomes were significantly higher among women with peripartum CMP compared to hypertrophic CMP or other CMP (46% vs. 23% vs. 39%, respectively, p < 0.001). In multivariate models, independent factors associated with adverse outcomes including peripartum CMP (OR, 2.2; 95% CI, 1.1-4.6), valvular disease (OR, 2.11; 95% CI, 1.6-2.9), and eclampsia (OR, 5.0; 95% CI, 1.6-1.9). Among women with peripartum CMP, 46.1% experienced an adverse event.

Conclusions:

The authors concluded that women with CMP were at increased risk for adverse events during hospitalization for childbirth, and CMP was an independent risk factor for adverse events. Women with peripartum CMP appeared to have the highest risk for adverse events.

Perspective:

Identification of women with CMP is critical to reducing adverse events during childbirth. Further research related to the management of CMP among women of childbearing years is warranted.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Cardiomyopathies, Eclampsia, Heart Failure, Hypertrophy, Hospitalization, Female, Peripartum Period, Pregnancy, Risk, Risk Factors, Arrhythmias, Cardiac, Inpatients, Secondary Prevention


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