Outcomes of Peripartum Cardiomyopathy in African American Women

Study Questions:

How does peripartum cardiomyopathy (PPCM) differ in African Americans compared to non-African Americans?

Methods:

This was a retrospective chart review of patients with PPCM at the University of Pennsylvania Health System from January 1, 1986 to December 31, 2016. Clinical characteristics, echocardiographic findings, and outcomes were compared between African American and non-African American women.

Results:

Of 220 women with PPCM, 121 (55%) were African American. Compared with non-African American women, African American women were younger at diagnosis (27.6 vs. 31.7 years, p < 0.001), diagnosed later in the postpartum period, more likely to present with ejection fraction <30% (56.5% vs. 39.5%, p = 0.03), and more likely to worsen after initial diagnosis (35.3% vs. 18.4%, p = 0.02). Among those who recovered, African Americans took twice as long (median, 265 vs. 125.5 days; p = 0.02). There were no significant differences in prescription rates of angiotensin-converting enzyme inhibitors or beta-blockers.

Conclusions:

The authors concluded that African American women with PPCM fare markedly worse than non-African American women.

Perspective:

Prior research has demonstrated that African Americans have a higher incidence of PPCM, in addition to worse prognosis. This is a large retrospective cohort study that highlights and defines specific ways in which African Americans with PPCM have worse outcomes. In this study, more African Americans had an initial ejection fraction <30% and were also diagnosed later in the postpartum period. Both low ejection fraction and delays in diagnosis have also been associated with lower rates of recovery. We still do not understand why African Americans with PPCM have a worse clinical profile. The authors postulate there may be genetic differences that have yet to be characterized. Socioeconomic differences and healthcare disparities are also possible explanations. Future research about racial differences in PPCM is needed.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Adrenergic beta-Antagonists, African Americans, Angiotensin-Converting Enzyme Inhibitors, Cardiomyopathy, Dilated, Echocardiography, Healthcare Disparities, Heart Failure, Peripartum Period, Postpartum Period, Prognosis, Puerperal Disorders, Stroke Volume, Vascular Diseases, Women


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