Abstract 9381: Comparison of Clinical Characteristics and Adverse Outcomes in Pregnant Women with Cardiomyopathy Subtypes at the Time of Delivery in the US: 2006-2010

Abstract

Introduction: Investigation of patient characteristics and outcomes in women with cardiomyopathy (CDM) at the time of delivery has been limited. The aim of this study was to determine the clinical characteristics and outcomes in women with peripartum (PCDM) and hypertrophic cardiomyopathy (HCDM), and the predictors for adverse clinical outcomes in pregnant women at the time of delivery. Methods and Results: The Healthcare Cost and Utilization Project’s National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with CDM subtypes (peripartum, hypertrophic and all others) from 2006-2010. Clinical characteristics and maternal outcomes were identified in women with subtypes of CDM and without. The primary outcome of interest was major adverse clinical events (MACE), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, or embolic event. Our study population consisted of 2,078 patients with CDM and 4,438,439 patients without CDM. Of those with CDM, 52 (2.5%) had HCDM, 1039 (50.0%) had PCDM, and 987 (47.5%) were classified as other CDM (OCDM). PCDM cohort was more likely to be insured by Medicaid and the HCDM patients were more likely to deliver at a teaching hospital (p<0.01 for all). The PCDM and all OCDM cohorts had a larger proportion of black patients and most were from the South. PCDM patients experienced the highest rates of MACE (46%), compared with HCDM (23%) or OCDM (38.9%), mainly driven by heart failure and arrhythmia. Maternal mortality in all CDM subgroups was extremely low (< 0.5%). Significant predictors of MACE in the PCDM cohort were the presence of valvular heart disease (OR 2.16, 95% CI 1.49-3.14), severe pre-eclampsia (OR 1.54, 95% CI: 1.08-2.21), and Cesarean delivery (OR 1.36, 95% CI: 1.04-1.78); delivery at a teaching hospital was associated with a reduction in MACE. In multivariable analysis, the presence of PCDM (OR 2.22, 95% CI 1.07-4.55) was independently predictive of MACE. Conclusions: Peripartum CDM patients had the highest likelihood of MACE compared to hypertrophic and all other CDM subtypes.