Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Mayo Clin Proc. 2019 May;94(5):811-819. doi: 10.1016/j.mayocp.2018.08.032. Epub 2018 Dec 19.
To study the association between hypertensive diseases of pregnancy and immediate postpartum development of heart failure in a large national database.
Using the 2013 to 2014 National Readmissions Database, which covered admissions from January 1 through September 30 in years 2013 and 2014, we examined 90-day readmission rates in parturients with a diagnosis of hypertensive disease of pregnancy who were discharged after delivery. The primary outcome was the association between the presence of hypertensive disease of pregnancy and readmission with heart failure within 90 days of delivery discharge. Secondary outcomes included readmission mortality, time between delivery discharge and readmission, length of stay, and costs of readmission.
Women with hypertensive disease of pregnancy were more likely to be readmitted with heart failure (1809 of 25,908 readmissions (7.0%) vs 2622 of 89,660 readmissions (2.9%); P<.001). This difference persisted after adjustment for potential cofounders (6.3% vs 3.1%; odds ratio, 2.15; 95% CI, 1.92-2.40; P<.001). Women with a diagnosis of heart failure at readmission were readmitted sooner (11 days vs 23 days; P<.001) and had a longer length of stay (4 days vs 3 days; P<.001) and higher costs of readmission ($10,361 vs $6977; P<.001) than did women without a diagnosis of heart failure.
Parturients with hypertensive disease of pregnancy were more likely to be readmitted with heart failure within 90 days of delivery. Most patients readmitted with heart failure were readmitted within 2 weeks of discharge after delivery. Patients readmitted with heart failure had substantial health care expenditures.
在大型国家数据库中研究妊娠高血压疾病与产后立即发生心力衰竭之间的关联。
利用 2013 年至 2014 年的全国再入院数据库，该数据库涵盖了 2013 年和 2014 年 1 月 1 日至 9 月 30 日期间的入院情况，我们检查了分娩后出院的妊娠高血压疾病患者 90 天内再入院率。主要结局是妊娠高血压疾病的存在与产后出院后 90 天内心力衰竭再入院之间的关系。次要结局包括再入院死亡率、从分娩出院到再入院的时间、住院时间和再入院费用。
患有妊娠高血压疾病的女性更有可能因心力衰竭而再次入院（25908 例再入院中有 1809 例[7.0%]与 89660 例再入院中有 2622 例[2.9%]；P<.001）。在调整了潜在混杂因素后，这种差异仍然存在（6.3%比 3.1%；优势比，2.15；95%置信区间，1.92-2.40；P<.001）。再次入院时诊断为心力衰竭的女性再入院时间更早（11 天比 23 天；P<.001），住院时间更长（4 天比 3 天；P<.001），再入院费用更高（10361 美元比 6977 美元；P<.001）。
妊娠高血压疾病患者产后 90 天内心力衰竭再入院的可能性更高。大多数因心力衰竭再次入院的患者是在分娩后出院后 2 周内再次入院。因心力衰竭再次入院的患者有大量的医疗支出。
