Abstract 29: Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population-Based Study

Abstract

Background: The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM. Objectives: To determine the overall incidence and complication rates of PPCM, and to analyze temporal trends in incidence and outcomes of PPCM in the United States. Methods: We queried the 2004 to 2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM using ICD-9-CM codes 674.5x. Temporal trends in incidence (per 10,000 live births), maternal major adverse events (MAE defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and length of stay were analyzed. Results: From 2004 to 2011, we identified 34,219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10,000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10,000 live births (p trend <0.001) during the study period. MAE occurred in 13.5% of patients. The most common complication in women with PPCM was thromboembolism (6.6%). The incidence of other complications was - in-hospital mortality in 1.3%, cardiac arrest in 2.1%, heart transplant in 0.5%, use of mechanical circulatory support in 1.5%, acute pulmonary edema in 1.8%, ICD/PPM placement in 2.9%, and cardiogenic shock in 2.6% There was no temporal change in MAE rate, except a small increase in in-hospital mortality [0.7% in 2004 to 1.8% in 2011, adjusted OR (per year) 1.08, 95% CI 1.02-1.14, p trend =0.006] and use of mechanical circulatory support [0.9% in 2004 to 2.2% in 2011, adjusted OR (per year) 1.08, 95% CI 1.03-1.14, p trend =0.002]. Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 [adjusted OR (per year) 1.16, 95% CI 1.11-1.21, p trend <0.001]. Mean length of stay decreased during the study period. Conclusion: From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, need for mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.