Pregnancy-related HF raises risk for adverse outcomes
Women who were hospitalized for HF during or after pregnancy had an increased risk for maternal morbidities and mortality, according to a study published in Circulation: Heart Failure.
“Early identification of women at increased risk of developing HF would likely allow clinicians to initiate monitoring and early intervention,” Mulubrhan F. Mogos, PhD, MSc, assistant professor in the department of women, children and family health science at the University of Illinois at Chicago College of Nursing, and colleagues wrote. “Women are usually discharged from the hospital within 2 to 3 days after delivery and not evaluated by their health care providers again until 6 weeks postpartum. At-risk mothers require surveillance during this period, ideally from a multidisciplinary team that includes HF specialists.”
Researchers analyzed data from 50,995,050 of patients aged 13 to 49 years from 2001 to 2011. Data were retrieved from the Nationwide Inpatient Sample. Antepartum, delivery and postpartum discharges were included in the study.
Outcomes of interest included acute renal failure, in-hospital mortality, stroke, pulmonary edema, length of hospital stay, puerperal cerebrovascular disease, mechanical ventilation, disseminated intravascular coagulation and cesarean section.
There were 112 cases of HF per 100,000 pregnancy-related hospitalizations (95% CI, 107-118). Pregnancy-related hospitalizations occurred in 1.5% of women during the postpartum period. Approximately 60% of pregnancy-related HF took place during the postpartum period, vs. 27% during the delivery period and 13% during the antepartum period.
HF prevalence in women hospitalized during the postpartum period increased by 7.1% from 2001 to 2006 (95% CI, 4.4-9.8), according to the researchers. From 2006 to 2011, there were no significant temporal changes.
HF prevalence increased by 4.9% annually from 2001 to 2011 in patients hospitalized during the antepartum period (95% CI, 3-6.8).
Women who were diagnosed with HF had an increased risk for adverse maternal outcomes during the antepartum (adjusted ORs between 2.7 and 25), delivery (aORs between 6 and 195) and postpartum (aORs between 1.5 and 6.6) periods.
“The leveling off of the HF rate was preceded by several national initiatives led by organizations such as the American Heart Association to increase awareness about cardiovascular health among women in the general population,” Mogos and colleagues wrote. “However, the increasing HF rates among antepartum hospitalizations, coupled with increasing in-hospital mortality rates observed among women with an HF diagnosis, underscore the need to improve prevention and intervention programs.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.