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Peripartum cardiomyopathy delivery hospitalization and postpartum readmission trends, risk factors, and outcomes. | LitMetric

AI Article Synopsis

  • The study aims to assess the risks associated with peripartum cardiomyopathy during and after delivery, including trends and clinical outcomes based on data from the Nationwide Readmissions Database from 2010-2020.
  • An analysis of 39.79 million delivery hospitalizations showed a low incidence of peripartum cardiomyopathy (2.3 per 10,000), but certain risk factors like severe preeclampsia and older maternal age significantly increased its likelihood during delivery and postpartum.
  • The findings indicate that peripartum cardiomyopathy is linked to severe adverse outcomes, contributing to a notable percentage of postpartum deaths and complications, and its occurrence during delivery hospitalizations is on the rise.

Article Abstract

Objective: To evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes.

Methods: The 2010-2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed. Risk factors associated with peripartum cardiomyopathy were analyzed with unadjusted and adjusted logistic regression models with odds ratios as measures of effect. Risk for severe adverse outcomes associated with peripartum cardiomyopathy was analyzed. Trends were analyzed with joinpoint regression.

Results: Of 39,790,772 delivery hospitalizations identified, 9,210 were complicated by a diagnosis of peripartum cardiomyopathy (2.3 per 10,000). Risk for a 5-month readmission with a peripartum cardiomyopathy diagnosis was 4.8 per 10,000. Factors associated with peripartum cardiomyopathy during deliveries included preeclampsia with severe features (OR 18.9, 95 % CI 17.2, 20.7), preeclampsia without severe features (OR 6.9, 95 % CI 6.1, 7.8), multiple gestation (OR 4.7, 95 % CI 4.1, 5.3), chronic hypertension (OR 10.1, 95 % CI 8.9, 11.3), and older maternal age. Associations were attenuated but retained significance in adjusted models. Similar estimates were found when evaluating associations with postpartum readmissions. Peripartum cardiomyopathy readmissions were associated with 10 % of overall postpartum deaths, 21 % of cardiac arrest/ventricular fibrillation diagnoses, 18 % of extracorporeal membrane oxygenation cases, and 40 % of cardiogenic shock. In joinpoint analysis, peripartum cardiomyopathy increased significantly during delivery hospitalizations (average annual percent change [AAPC] 2.2 %, 95 % CI 1.0 %, 3.4 %) but not postpartum readmissions (AAPC 0.0 %, 95 % CI -1.6 %, 1.6 %).

Conclusion: Risk for peripartum cardiomyopathy increased during delivery hospitalizations over the study period. Obstetric conditions such as preeclampsia and chronic medical conditions that are increasing in prevalence in the obstetric population were associated with the highest odds of peripartum cardiomyopathy.

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Source
http://dx.doi.org/10.1016/j.preghy.2023.11.004DOI Listing

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