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National Trends and In-Hospital Outcomes in Pregnant Women With Heart Disease in the United States

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Investigation of trends and outcomes in heart disease (HD) and pregnancy has been limited. We chose to identify the prevalence, trends, and outcomes of pregnant women with different forms of HD in the United States. Healthcare Cost and Utilization Project's National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with HD from 2003 to 2012. Maternal clinical characteristics and outcomes were identified in women with and without HD, and in HD subtypes: congenital (CHD), valvular HD, cardiomyopathy, and pulmonary hypertension (PH). Primary outcomes of interest were prevalence, trends, and major adverse cardiac events (MACEs), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, embolic events, or cardiac complications of anesthesia. We studied 81,295 patients with HD and 39,894,032 without. CHD was the most frequent type (41.8%, 33,982 of 81,295 patients), followed by valvular HD (30.9%, 25,138 of 81,295 patients), cardiomyopathy (20.8%, 16,926 of 81,295 patients), and PH (6.5%, 5,250 of 81,295 patients). MACE was highest among women with cardiomyopathy and lowest among women with CHD (44.0%, 7,449 of 16,926 vs 6.2%, 2,102 of 33,982; p <0.0001). PH patients had the highest in-hospital death, followed by cardiomyopathy patients (1.0%, 51 of 5,250 and 0.7%, 124 of 16,926, respectively). Pregnant women with HD significantly increased by 24.7%, related to increases in cardiomyopathy, CHD, and PH from 2003 to 2012. MACE significantly increased by 18.8%. In conclusion, pregnancy in women with HD is increasing, particularly for high risk conditions such as cardiomyopathy and PH. There is a significant and gradual increase in MACE for women with HD.

Section snippets

Methods

We utilized data from the 2003 to 2012 National Inpatient Sample (NIS), collected by the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, which is the largest all-payer inpatient publicly available database in the United States.9 NIS provides annual information on approximately 8 million inpatient stays from about 1,000 hospitals, and estimates a 20% stratified sample from a sampling frame that comprises 90% of US acute care hospital admissions. To facilitate

Results

Clinical and demographic characteristics of all women with HD at delivery (n = 81,295) and those without (n = 39,894,032) groups are summarized in Table 1. Compared with women without HD, those patients with HD were more likely to be white, insured by Medicare, have diabetes mellitus and multiple gestation, and undergo deliveries in an urban-teaching hospital located in the northeast or midwest (p <0.05 for all). Patients with HD had a higher prevalence of transient hypertension, pre-eclampsia

Discussion

The annual number of hospitalizations for delivery in women with HD in the United States, particularly cardiomyopathy, CHD, and PH, has significantly increased, with a significant and gradual increase in MACEs. The cardiomyopathy cohort had the highest rates of MACEs, highest total hospital charges, and longest length of stay, while CHD had the lowest PH and cardiomyopathy patients demonstrated the highest in-hospital mortality.

The NIS was used to illustrate national trends in HD and its

Acknowledgment

We acknowledge the statistical support provided by the Biostatistical Consulting Core at the Stony Brook School of Medicine, Stony Brook, New York.

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