Sunki Lee1, Geum Joon Cho1, Geun U Park1, Log Young Kim1, Tae-Seon Lee1, Do Young Kim1, Suk-Won Choi1, Jong-Chan Youn1, Seong Woo Han1, Kyu-Hyung Ryu1, Jin Oh Na1, Cheol Ung Choi1, Hong Seog Seo1, Eung Ju Kim2. 1. Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea (S.L., D.Y.K., S.-W.C., J.-C.Y., S.W.H., K.-H.R.). Department of Obstetrics and Gynecology (G.J.C.) and Department of Cardiology (J.O.N., C.U.C., H.S.S., E.J.K.), Korea University Guro Hospital, Seoul, South Korea. Department of Applied Statistics, Chung-Ang University, Seoul, South Korea (G.U.P.). Healthcare Data Convergence Department, Health Insurance Review and Assessment Service, Seoul, South Korea (L.Y.K., T.-S.L.). 2. Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea (S.L., D.Y.K., S.-W.C., J.-C.Y., S.W.H., K.-H.R.). Department of Obstetrics and Gynecology (G.J.C.) and Department of Cardiology (J.O.N., C.U.C., H.S.S., E.J.K.), Korea University Guro Hospital, Seoul, South Korea. Department of Applied Statistics, Chung-Ang University, Seoul, South Korea (G.U.P.). Healthcare Data Convergence Department, Health Insurance Review and Assessment Service, Seoul, South Korea (L.Y.K., T.-S.L.). withnoel@empal.com.
Abstract
BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare disorder associated with pregnancy that can lead to life-threatening conditions. The incidence and clinical characteristics of this condition remain poorly understood. METHODS AND RESULTS: We aimed to perform the first population-based study of PPCM in South Korea, using the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who fulfilled predefined diagnostic criteria for PPCM from January 1, 2010, to December 31, 2012, were identified from International Classification of Diseases, Tenth Revision, Clinical Modification codes. To discriminate PPCM from other causes of heart failure, we excluded subjects who already had heart failure-related International Classification of Diseases, Tenth Revision, Clinical Modification codes at least 1 year before delivery. During the study period, there were 1 404 551 deliveries in South Korea, and we excluded 20 159 patients who already had heart failure. In those, a total of 795 cases were identified as PPCM. Patients with PPCM were older, had a higher prevalence of preeclampsia and gestational diabetes mellitus, and were more likely to be primiparous and have multiple pregnancies. Moreover, cesarean section and pregnancy-related complications and in-hospital death were also more common in patients with PPCM. Intriguingly, a considerable number of heart failure cases (n=64; 8.1% of total PPCM) were noted between 5 and 12 months after delivery. CONCLUSIONS: The incidence of PPCM was 1 in 1741 deliveries in South Korea. Patients with PPCM were older, were more associated with primiparity and multiple pregnancy, had more pregnancy-related complications, and revealed higher in-hospital mortality than controls. The number of cases diagnosed as PPCM were decreased over time after delivery; however, a large number of patients were still noted through 12 months after delivery.
BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare disorder associated with pregnancy that can lead to life-threatening conditions. The incidence and clinical characteristics of this condition remain poorly understood. METHODS AND RESULTS: We aimed to perform the first population-based study of PPCM in South Korea, using the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who fulfilled predefined diagnostic criteria for PPCM from January 1, 2010, to December 31, 2012, were identified from International Classification of Diseases, Tenth Revision, Clinical Modification codes. To discriminate PPCM from other causes of heart failure, we excluded subjects who already had heart failure-related International Classification of Diseases, Tenth Revision, Clinical Modification codes at least 1 year before delivery. During the study period, there were 1 404 551 deliveries in South Korea, and we excluded 20 159 patients who already had heart failure. In those, a total of 795 cases were identified as PPCM. Patients with PPCM were older, had a higher prevalence of preeclampsia and gestational diabetes mellitus, and were more likely to be primiparous and have multiple pregnancies. Moreover, cesarean section and pregnancy-related complications and in-hospital death were also more common in patients with PPCM. Intriguingly, a considerable number of heart failure cases (n=64; 8.1% of total PPCM) were noted between 5 and 12 months after delivery. CONCLUSIONS: The incidence of PPCM was 1 in 1741 deliveries in South Korea. Patients with PPCM were older, were more associated with primiparity and multiple pregnancy, had more pregnancy-related complications, and revealed higher in-hospital mortality than controls. The number of cases diagnosed as PPCM were decreased over time after delivery; however, a large number of patients were still noted through 12 months after delivery.
Authors: Michael C Honigberg; Uri Elkayam; Navin Rajagopalan; Kalgi Modi; Joan E Briller; Mark H Drazner; Gretchen L Wells; Dennis M McNamara; Michael M Givertz Journal: Clin Cardiol Date: 2019-03-29 Impact factor: 2.882