From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.).
Circ Heart Fail. 2018 Jan;11(1):e004005. doi: 10.1161/CIRCHEARTFAILURE.117.004005.
Heart failure (HF) is a leading cause of maternal morbidity and mortality in the United States, but prevalence, correlates, and outcomes of HF-related hospitalization during antepartum, delivery, and postpartum periods remain unknown. The objective was to examine HF prevalence, correlates, and outcomes among pregnancy-related hospitalizations among women 13 to 49 years of age.
We used the 2001 to 2011 Nationwide Inpatient Sample. Rates of HF were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios representing the association between HF and each outcome, stratified by antepartum, delivery, and postpartum periods. Joinpoint regression was used to describe temporal trends in HF and in-hospital mortality. Over 50 million pregnancy-related hospitalizations were analyzed. The overall rate of HF was 112 cases per 100 000 pregnancy-related hospitalizations. Although postpartum encounters represented only 1.5% of pregnancy-related hospitalizations, ≈60% of HF cases occurred postpartum, followed by delivery (27.3%) and antepartum (13.2%). Among postpartum hospitalizations, there was a significant 7.1% (95% confidence interval, 4.4-9.8) annual increase in HF from 2001 to 2006, followed by a steady rate through 2011. HF rates among antepartum hospitalizations increased on average 4.9% (95% confidence interval, 3.0-6.8) annually from 2001 to 2011. Women with a diagnosis of HF were more likely to experience adverse maternal outcomes, as reflected by outcome-specific adjusted odds ratios during antepartum (2.7-25), delivery (6-195), and postpartum (1.5-6.6) periods.
HF is associated with increased risk of maternal mortality and morbidities. During hospitalization, high-risk mothers need to be identified and surveillance programs developed before discharge.
心力衰竭（HF）是美国孕产妇发病率和死亡率的主要原因，但围产前、分娩和产后期间与 HF 相关的住院率、相关因素和结局仍不清楚。本研究旨在调查年龄在 13 至 49 岁的妊娠相关住院患者中 HF 的发病率、相关因素和结局。
我们使用了 2001 年至 2011 年的全国住院患者样本。通过患者和医院特征计算 HF 发生率。使用调查逻辑回归来估计调整后的优势比，代表 HF 与每个结局之间的关联，按围产前、分娩和产后期间分层。连接点回归用于描述 HF 和院内死亡率的时间趋势。共分析了超过 5000 万例妊娠相关住院患者。HF 的总体发病率为每 100000 例妊娠相关住院患者中有 112 例。尽管产后住院仅占妊娠相关住院的 1.5%，但约 60%的 HF 病例发生在产后，其次是分娩（27.3%）和围产前（13.2%）。在产后住院患者中，从 2001 年至 2006 年，HF 发病率每年显著增加 7.1%（95%置信区间，4.4-9.8），之后到 2011 年保持稳定。从 2001 年至 2011 年，围产前住院患者的 HF 发病率平均每年增加 4.9%（95%置信区间，3.0-6.8）。患有 HF 诊断的女性更有可能经历不良的孕产妇结局，这反映了特定于结局的调整后的优势比在围产前（2.7-25）、分娩（6-195）和产后（1.5-6.6）期间的变化。
HF 与增加的孕产妇死亡率和发病率相关。在住院期间，需要在出院前识别高危产妇，并制定监测计划。
