Karen Sliwa1, Feriel Azibani2, Johann Baard2, Ayesha Osman3, Liesl Zühlke4, Anthony Lachmann5, Elena Libhaber6, Ashley Chin7, Mpiko Ntsekhe7, Priya Soma-Pillay8, Mark R Johnson9, Jolien Roos-Hesselink10, John Anthony3. 1. Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Cardiology, Department of Medicine Groote Schuur Hospital, University of Cape Town, South Africa; Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa. Electronic address: Karen.Sliwa-Hahnle@uct.ac.za. 2. Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. 3. Division of Obstetrics and Gynaecology Groote Schuur Hospital, University of Cape Town, South Africa. 4. Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. 5. Division of Obstetrics and Gynaecology Groote Schuur Hospital, University of Cape Town, South Africa; Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. 6. Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa. 7. Division of Cardiology, Department of Medicine Groote Schuur Hospital, University of Cape Town, South Africa. 8. Department of Obstetrics and Gynecology, Maternal and Foetal Medicine, Steve Biko Academic Hospital, University of Pretoria, South Africa. 9. Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom. 10. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
BACKGROUND: Late maternal mortality (up-to 1-year postpartum) is poorly reported globally and is commonly due to cardiovascular disease (CVD). We investigated targeted interventions aiming at reducing peripartum heart failure admission and late maternal death. METHODS AND RESULTS: Prospective single-centre study of 269 peripartum women presenting with CVD in pregnancy, or within 6-months postpartum. Both cardiac disease maternity (CDM) Group-I and Group-II were treated by a dedicated cardiac-obstetric team. CDM Group-II received additional interventions: 1. Early (2-6 weeks) postpartum follow-up at the CDM clinic and immediate referral to dedicated CVD specialist clinics. 2. Beta-blocker therapy was continued in women with LVEF<45% while pregnant, or immediately started postpartum. Of 269 consecutive women (mean age 28.6 ± 5.9), 213 presented prepartum, 22% in NYHA groups III-IV and 79% in modified WHO groups III-IV. Patients were diagnosed with congenital heart disease (30%), valvular heart disease (25%) and cardiomyopathy (31%). The groups were similar in age, diagnosis, NYHA, modified WHO, BP and HIV, but Group-II had a higher rate of previously known CVD (p < 0.001) and a lower rate of being nulliparous (p < 0.0005). Of Group-I patients 9 died within the 12-month follow-up period versus one death in Group-II (p = 0.047). Heart failure leading to admission was 32% in Group-I versus 14% in Group-II (p = 0.0008), with Group-II having a higher beta-blocker use peripartum (p = 0.009). Perinatal mortality rate was 22/1000 live births with no differences between groups. CONCLUSION: Early follow-up in a dedicated CDM clinic with targeted pharmacological interventions led to a significant reduction in peripartum heart failure admission and mortality. Crown
BACKGROUND: Late maternal mortality (up-to 1-year postpartum) is poorly reported globally and is commonly due to cardiovascular disease (CVD). We investigated targeted interventions aiming at reducing peripartum heart failure admission and late maternal death. METHODS AND RESULTS: Prospective single-centre study of 269 peripartum women presenting with CVD in pregnancy, or within 6-months postpartum. Both cardiac disease maternity (CDM) Group-I and Group-II were treated by a dedicated cardiac-obstetric team. CDM Group-II received additional interventions: 1. Early (2-6 weeks) postpartum follow-up at the CDM clinic and immediate referral to dedicated CVD specialist clinics. 2. Beta-blocker therapy was continued in women with LVEF<45% while pregnant, or immediately started postpartum. Of 269 consecutive women (mean age 28.6 ± 5.9), 213 presented prepartum, 22% in NYHA groups III-IV and 79% in modified WHO groups III-IV. Patients were diagnosed with congenital heart disease (30%), valvular heart disease (25%) and cardiomyopathy (31%). The groups were similar in age, diagnosis, NYHA, modified WHO, BP and HIV, but Group-II had a higher rate of previously known CVD (p < 0.001) and a lower rate of being nulliparous (p < 0.0005). Of Group-I patients 9 died within the 12-month follow-up period versus one death in Group-II (p = 0.047). Heart failure leading to admission was 32% in Group-I versus 14% in Group-II (p = 0.0008), with Group-II having a higher beta-blocker use peripartum (p = 0.009). Perinatal mortality rate was 22/1000 live births with no differences between groups. CONCLUSION: Early follow-up in a dedicated CDM clinic with targeted pharmacological interventions led to a significant reduction in peripartum heart failure admission and mortality. Crown
Authors: Matthew M Coates; Karen Sliwa; David A Watkins; Liesl Zühlke; Pablo Perel; Florence Berteletti; Jean-Luc Eiselé; Sheila L Klassen; Gene F Kwan; Ana O Mocumbi; Dorairaj Prabhakaran; Mahlet Kifle Habtemariam; Gene Bukhman Journal: Lancet Glob Health Date: 2021-05-10 Impact factor: 38.927
Authors: Steffie Heemelaar; Ndatiyaroo Agapitus; Thomas van den Akker; Jelle Stekelenburg; Shonag Mackenzie; Christopher Hugo-Hamman; Tangeni Auala Journal: Trop Med Int Health Date: 2022-08-18 Impact factor: 3.918