Division of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Heart. 2018 Dec;104(23):1949-1954. doi: 10.1136/heartjnl-2018-313156. Epub 2018 May 25.
The goal of this study is to report the prevalence, aetiology and clinical outcome of pregnant women with heart failure.
This is a retrospective community-based cohort study that included pregnant women in the Kaiser Permanente Health System between 2003 and 2014. Women with heart failure were identified using International Classification of Disease, Ninth Revision codes. Medical records were manually reviewed to confirm diagnosis and adjudicate outcomes.
In a cohort of 385 935 pregnancies, 488 (0.13%) had a diagnosis of heart failure, corresponding to 126 cases per 100 000 pregnancies. Peripartum cardiomyopathy was the most common cause of heart failure, accounting for 333 (68.2%) cases. Preterm birth and caesarean delivery were more common in patients with heart failure. Neonatal death rate was higher in the heart failure group (1.0% vs 0.4%, p=0.03). Infants delivered to women with heart failure had lower birth weights (3112.0±774.0 g vs 3331.9±575.5 g, p<0.001) and lower Apgar score at 1 min (7.9±1.5 vs 8.3±1.1, p<0.001). Median follow-up was 6.2 years (IQR 3.2-9.2). During follow-up, 7 (1.4%) in the heart failure group and 423 (0.11%) in the control group died. Heart failure was associated with a 7.7-fold increase risk of death (adjusted HR 7.7, 95% CI 3.6 to 16.4, p<0.001).
Heart failure during pregnancy is associated with unfavourable fetal outcomes including prematurity and low birth weight. While the overall mortality rate was low, pregnant women with heart failure carried an excess risk of death compared with controls.
本研究旨在报告心力衰竭孕妇的患病率、病因和临床结局。
这是一项回顾性基于社区的队列研究，纳入了 2003 年至 2014 年期间 Kaiser Permanente 医疗系统中的孕妇。使用国际疾病分类，第九版代码识别心力衰竭患者。通过手动审查病历来确认诊断并判断结局。
在 385935 例妊娠中，有 488 例（0.13%）诊断为心力衰竭，相当于每 100000 例妊娠中有 126 例。围产期心肌病是心力衰竭的最常见病因，占 333 例（68.2%）。心力衰竭患者中早产和剖宫产更为常见。心力衰竭组新生儿死亡率较高（1.0%比 0.4%，p=0.03）。心力衰竭产妇所分娩的婴儿出生体重较低（3112.0±774.0g 比 3331.9±575.5g，p<0.001），1 分钟时的 Apgar 评分较低（7.9±1.5 比 8.3±1.1，p<0.001）。中位随访时间为 6.2 年（IQR 3.2-9.2）。随访期间，心力衰竭组有 7 例（1.4%）和对照组有 423 例（0.11%）死亡。心力衰竭使死亡风险增加 7.7 倍（调整后的 HR 7.7，95%CI 3.6 至 16.4，p<0.001）。
妊娠期间心力衰竭与不良胎儿结局相关，包括早产和低出生体重。虽然总体死亡率较低，但与对照组相比，心力衰竭孕妇的死亡风险仍然较高。
