Joan E. Briller, MD Division of Cardiology, Department of Medicine, University of Illinois at Chicago speaks about Pregnancy Associated Heart Failure With Preserved Ejection Fraction: Risk Factors and Maternal Morbidity.
Link to Article:
• Pregnancy-related heart loss with retained ejection fraction (HFpEF) hospitalizations have risen by more than 19 percent per year.
• HFpEF admissions are driven by chronic hypertension and hypertensive pregnancy conditions.
• Women who were black, older, or weaker had a higher percentage of HFpEF hospitalizations.
• Pregnancy-related HFpEF is often linked with negative pregnancy outcomes.
Background information -
Cardiovascular disease is one of the main causes of maternal morbidity and mortality. The majority of HF admissions in women are due to heart failure with retained ejection fraction (HFpEF), but its effect on pregnancy is unclear. During pregnancy-related hospitalizations in the United States, we looked at the prevalence rates, risk factors, and unfavorable pregnancy effects in women with HFpEF.
Results and Methods -
Using the National Inpatient Sample, we performed a cross-sectional study of pregnancy-related hospitalizations from 2002 to 2014. The 428.3 International Classification of Diseases, 9th edition, Clinical Modification code was used to identify HFpEF cases. For national projections, weighting variables were used, and unconditional survey logistic regression was used to derive odds ratios and 95 percent confidence intervals (CI) reflecting modified correlations with adverse pregnancy outcomes, as well as Joinpoint regression to predict temporal patterns. There were 3840 HFpEF cases out of 58,732,977 hospitalizations, with a prevalence of 7 cases per 100,000 pregnancy-related hospitalizations; 56 percent occurred postpartum, 27 percent during birth, and 17 percent occurred antepartum. The hospitalization rate rose by 19.4 percent (95 percent confidence interval 13.9–25.1) over time. Hospitalizations due to HFpEF were more frequent in Black, elderly, and disadvantaged women. Hypertension (chronic hypertension and pregnancy-related hypertension), anemia, obesity, asthma, kidney dysfunction, and coronary atherosclerosis were all identified as risk factors for HFpEF. Women with HFpEF had a 2.61–6.47 times higher chance of having a bad pregnancy.
Final thoughts -
The rate of HFpEF hospitalization during pregnancy has increased, and it is linked to poor pregnancy outcomes. The risk factors are similar to those found outside of pregnancy, highlighting the importance of screening and tracking women with risk factors for HFpEF during pregnancy.