301: Postpartum readmissions for cardiac indications among women without a history of cardiac disease

Abstract

To determine risk of postpartum readmissions for cardiac indications among women without a history of cardiac disease. Delivery hospitalizations with no cardiac diagnoses were identified from the 2010-2014 Nationwide Readmissions Database and linked with subsequent cardiac hospitalizations over the following 9 months. Cardiac readmissions were defined as readmissions with cardiac interventions or diagnoses including cardiomyopathy or heart failure. Temporality of new onset cardiac hospitalizations was calculated for each 30-day interval from delivery discharge up to 9 months postpartum. Multivariable log linear regression models were fit to identify risk factors for cardiac readmissions adjusting for patient, medical, obstetrical, and hospital factors. A sensitivity analysis was repeated restricted to readmissions where cardiac causes were the primary indication for readmission. Of 4.5 million deliveries, the readmission rate for new onset cardiac condition was 27 per 10,000 low risk deliveries. 56.2% occurred within the first 60 days with persistence in the extended postpartum period (Figure 1). Factors such as lupus (RR 4.52, 95% CI: 3.73-5.46), hypertensive diseases of pregnancy (RR 2.17, 95% CI: 2.07-2.27), thromboembolism (RR 3.05, 95% CI: 2.27-4.08), or severe maternal morbidity at delivery (RR 2.30, 95% CI: 2.05-2.57) were associated with significantly increased risks of cardiac readmission (Table 1). Similar results were noted in our sensitivity analyses. Among low risk patients, multiple medical factors and obstetrical complications are associated with development of new cardiac disease requiring readmission in the postpartum period. These patients may benefit from improved surveillance in the early postpartum period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)