Joan E Briller1, Mulubrhan F Mogos2, James M Muchira2, Mariann R Piano2. 1. Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA;. Electronic address: briller@uic.edu. 2. Center for Research Development and Scholarship, Vanderbilt University, School of Nursing, Nashville, TN, USA.
Abstract
BACKGROUND: Cardiovascular conditions are leading contributors to rising maternal morbidity and mortality. Heart Failure with preserved ejection fraction (HFpEF) results in the majority of heart failure admissions in women, yet its impact in pregnancy is unknown. We examined prevalence rates, risk factors and adverse pregnancy outcomes in women with HFpEF during pregnancy-related hospitalizations in the United States. METHODS: We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2002 through 2014 using the National Inpatient Sample. HFpEF cases were identified using the 428.3 International Classification of Diseases, 9th Edition, Clinical Modification code. Weighting variables were used to provide national estimates, unconditional survey logistic regression to generate odds ratios and 95% confidence intervals representing adjusted associations with adverse pregnancy outcomes and Joinpoint regression to estimate temporal trends. RESULTS: Among 58,732,977 hospitalizations, there were 3,840 HFpEF cases, an overall rate of 7 cases/100,000 pregnancy-related hospitalizations; 56% occurred postpartum, 27% during delivery and 17% antepartum. Temporal trend for hospitalization increased throughout the timeframe by 19.4% (CI: 13.9, 25.1). HFpEF hospitalizations were more common for Black, older, or poor women. Risk factors included hypertension (chronic hypertension and hypertensive disorders of pregnancy), anemia, obesity, diabetes, renal disease and coronary atherosclerosis; all known risk factors for HFpEF. Women with HFpEF were 2.61 to 6.47 times more likely to experience adverse pregnancy outcomes. CONCLUSIONS: Pregnancy-related HFpEF hospitalization prevalence has increased and is associated with adverse pregnancy outcomes. Risk factors resemble those outside pregnancy, emphasizing the need for screening and monitoring women with risk factors during pregnancy for HFpEF.
BACKGROUND: Cardiovascular conditions are leading contributors to rising maternal morbidity and mortality. Heart Failure with preserved ejection fraction (HFpEF) results in the majority of heart failure admissions in women, yet its impact in pregnancy is unknown. We examined prevalence rates, risk factors and adverse pregnancy outcomes in women with HFpEF during pregnancy-related hospitalizations in the United States. METHODS: We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2002 through 2014 using the National Inpatient Sample. HFpEF cases were identified using the 428.3 International Classification of Diseases, 9th Edition, Clinical Modification code. Weighting variables were used to provide national estimates, unconditional survey logistic regression to generate odds ratios and 95% confidence intervals representing adjusted associations with adverse pregnancy outcomes and Joinpoint regression to estimate temporal trends. RESULTS: Among 58,732,977 hospitalizations, there were 3,840 HFpEF cases, an overall rate of 7 cases/100,000 pregnancy-related hospitalizations; 56% occurred postpartum, 27% during delivery and 17% antepartum. Temporal trend for hospitalization increased throughout the timeframe by 19.4% (CI: 13.9, 25.1). HFpEF hospitalizations were more common for Black, older, or poor women. Risk factors included hypertension (chronic hypertension and hypertensive disorders of pregnancy), anemia, obesity, diabetes, renal disease and coronary atherosclerosis; all known risk factors for HFpEF. Women with HFpEF were 2.61 to 6.47 times more likely to experience adverse pregnancy outcomes. CONCLUSIONS: Pregnancy-related HFpEF hospitalization prevalence has increased and is associated with adverse pregnancy outcomes. Risk factors resemble those outside pregnancy, emphasizing the need for screening and monitoring women with risk factors during pregnancy for HFpEF.
Authors: Dominique Williams; Molly J Stout; Joshua I Rosenbloom; Margaret A Olsen; Karen E Joynt Maddox; Elena Deych; Victor G Davila-Roman; Kathryn J Lindley Journal: J Am Coll Cardiol Date: 2021-12-07 Impact factor: 24.094