Abstract 18643: Longterm Mortality in 272 Women with Peripartum Cardiomyopathy

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is new-onset unexplained dilated cardiomyopathy with heart failure (HF) during the last months of pregnancy and the months following delivery. Prognosis and clinical course is highly variable and overall mortality in hospitalized cases unknown. Purpose: To determine long term mortality and predictors of outcome in women with PPCM in Sweden.

Methods: Through linking records from the Hospital Discharge Registry and Medical Birth Registry (MBR), cases eligible for inclusion were identified from subjects with a pregnancy associated HF or PPCM diagnosis. To determine time and mode of death, these were further linked to the Cause of Death Registry. Controls (5:1) matched for age and year of diagnosis were allocated from the MBR.

Results: From 1987 to 2010, we included 272 PPCM cases (1341 controls) with an average incidence rate of 1 in 9,191 live births (1 in 18,142 (1987-1991), and 1 in 6,549 (1996-2010)). A total of 22 cases and 5 controls died during the study period. Mean follow-up was 16.4 years. One-, 3-, 5- and 10-year all cause mortality was 4.0%, 5.9%, 5.9% and 7.0% among cases, and 0%, 0%, 0.15% and 0.22% among controls respectively (fig). The odds ratio (OR) of a fatal outcome in women with PPCM compared to controls was 23.5 (95%CI = 8.8; 62.6). Mortality among cases declined from 22.6% (1987-1996) to 3.8% (1997-2010), OR 5.93 (95%CI = 2.37; 14.78) for the first compared to the last period.

Conclusions: PPCM mortality was lower than indicated in previous reports from USA, but still much higher than in healthy controls. Deaths leveled off after 3 years from diagnosis. Though incidence more than doubled, mortality continued to decline.