Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
Heart. 2018 May;104(9):745-752. doi: 10.1136/heartjnl-2017-311910. Epub 2017 Nov 1.
Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.
The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).
A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.
While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome.
心脏疾病是导致产妇间接死亡的主要原因。本研究旨在分析社会经济因素在多大程度上影响患有心脏病的女性妊娠结局。
妊娠合并心脏疾病登记研究是一项全球性前瞻性登记研究。本分析纳入了至少纳入 10 名患者的国家。联合心脏终点包括产妇心源性死亡、需要治疗的心律失常、心力衰竭、血栓栓塞事件、主动脉夹层、心内膜炎、急性冠状动脉综合征、因心脏原因或干预而住院。在三级模型（患者-中心-国家）中检查了患者特征、国家特征（收入不平等程度表示为基尼系数、卫生支出、教育程度、国内生产总值、出生率和病床数）与心脏终点之间的关联。
共有 30 个国家的 89 个中心纳入了 2924 名患者。至少有一个终点发生在 645 名女性（22.1%）中。产妇年龄、纽约心脏协会分级和改良的世界卫生组织危险分级与联合终点相关，解释了结局差异的 37%。基尼系数和国家特定出生率解释了另外的 4%。个别国家之间存在很大差异，但在调整患者特征、基尼系数和国家特定出生率后，需要进行多层次建模来解释这些差异。
尽管患有心脏病的女性妊娠结局存在明显的区域间差异，但这些差异似乎主要由个体患者特征驱动。调整国家特征对结果的改善程度有限，但产妇病情似乎是结局的主要决定因素。
