Abstract 16089: Epidemiology and Outcomes of Peripartum Cardiomyopathy in United States From 2009-2010
Objective: Peripartum cardiomyopathy (PPCM) is defined as systolic heart failure within the last month of pregnancy or 5 months after delivery in the absence of any identifiable etiology of heart failure. Very little is known about the epidemiology and predictors of mortality. The objective of our study was to investigate the prevalence and predictors of mortality in patients with PPCM.
Methods: We analyzed patients with a diagnosis of PPCM from Nationwide Inpatient Sample (NIS) using ninth revision of International Classification of Diseases (ICD 9) from 2009-2010. We categorized PPCM into 3 groups based on ICD 9 codes - antepartum (674.53), peripartum (674.51,674.52) and 674.54-postpartum groups.
Results: Of 4,817 patients with PPCM, 189 were in antepartum, 887 in peripartum and 3,741 in postpartum group. PPCM was more common in blacks (n=1,722) as compared to whites (n=1,601), hispanics (n=343), asians (n=108) and native americans (n=24). Diabetes (15%) was more prevalent in antepartum, preeclampsia/eclampsia (41%) in peripartum group and hypertension (20.2%) was predominant in postpartum period. Amongst ethnic groups, hypertension, diabetes, heart failure were more prevalent in blacks while preeclampsia/eclampsia and preterm labor were common in asians. Although there was no mortality in antepartum period, mortality rate was 0.5% and 2.1% in peripartum and postpartum group, respectively. Asians had the highest mortality (8.5%) as compared to blacks (2.8%), whites (0.3%) and hispanics (0%). In unadjusted regression analysis, asians were associated with higher inpatient mortality (OR 5.91 95% CI 1.23-28.31, p=0.02) while whites had less risk (OR 0.11 95% CI 0.01-0.88, p=0.03). In multimodel analysis, length of stay was associated with increased inpatient mortality (OR 1.06 95% CI 1.003-1.13, p<0.05) while whites demonstrated lower inpatient mortality (OR 0.06 95% CI 0.003-0.61, P=0.02).
Conclusion: PPCM was more common in blacks however asians had high inpatient mortality, which might be explained by the increased prevalence of preeclampsia/eclampsia and premature labor amongst asians. Also, mortality rate was significantly higher in the postpartum group, possibly related to adverse hemodynamic changes in preload and afterload.
- © 2013 by American Heart Association, Inc.