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The relationship between peripartum cardiomyopathy with age and other risk factors

Session Acute heart failure: how to improve survival

Speaker Assistant Professor Sunki Lee

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Rapid Fire Abstracts

Authors : SK Lee (Dongtan,KR), MS Park (Dongtan,KR), SW Han (Dongtan,KR), KH Ryu (Dongtan,KR), EJ Kim (Seoul,KR)

SK Lee1 , MS Park1 , SW Han1 , KH Ryu1 , EJ Kim2 , 1Hallym University, Cardiovascular center - Dongtan - Korea Republic of , 2Korea University Guro Hospital, Cardiovascular Center, Korea University Guro Hospital - Seoul - Korea Republic of ,

Acute Heart Failure – Epidemiology, Prognosis, Outcome

Background: Peripartum cardiomyopathy (PPCM) is a significant cause of maternal morbidity and mortality, yet its etiology remains unclear. No comprehensive evaluation of the relationship between age and PPCM exists. In addition, little is known regarding the implications of risk factors in PPCM patients. Purpose: The purpose of this study was to evaluate the associations across quartiles of maternal age and the incidence of PPCM. Moreover, we sought to evaluate not only for independent risk factors of PPCM but also whether the clustering of risk factors of PPCM has a greater impact on PPCM prevalence. Methods: A systematic search strategy was performed by using the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Results: Patients with PPCM were older compared to control (32.1 ± 4.3 vs 30.9 ± 4.1, <0.001). Moreover, when divided into quartiles based on age, old maternal age was linearly associated with increasing prevalence of PPCM (P for trend < 0.001, Table). In multivariate analysis, Age = 35 years (OR 1.56, 95% CI 1.32 - 1.83), primiparity (OR 1.18, 95% CI 1.02 - 1.37), multiple pregnancy (OR 2.19, 95% CI 1.64 - 2.93), cesarean section (OR 2.59, 95% CI 2.15 - 3.14), preeclampsia (OR 6.02, 95% CI 4.94 - 7.34), and gestational DM (OR 1.70, 95% CI 1.26 - 2.29) were significantly correlated with PPCM. Intriguingly, the rate of PPCM was exponentially increased when clustering risk factors, and was approximately 200 times greater in patients with = 6 risk factors than in those with none. Conclusions: The incidence of PPCM was linearly associated with mother’s age at birth. PPCM patients were older, more associated with primiparity and multiple pregnancy, and had more pregnancy related complications than control. In addition, the number of risk factors amplifies the PPCM, emphasizing more intensive monitoring on those at high risk.

Age P trend
Q1 Q2 Q3 Q4
Age <29.9 30-34.9 35-39.9 ≥40
Total delivery number 488,135 653,890 213,164 28,465
PPCM number 204 363 193 35
Incidence of PPCM 1:2,393 1:1,801 1:1,104 1:813 <0.001
OR, risk factor adjusted* 1 1.25 1.78 1.96 <0.001
Incidence of peripartum cardiomyopathy in relation to quartiles of age

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