Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York.
Am J Cardiol. 2019 Jun 15;123(12):2006-2014. doi: 10.1016/j.amjcard.2019.03.012. Epub 2019 Mar 19.
There is limited data on postpartum maternal postpartum major adverse cardiovascular and cerebrovascular events (MACCE) among women with heart disease (HD) in the US. Therefore, we aimed to determine the prevalence and predictors of MACCE in the US. The Nationwide Readmissions Databases (2010 to 2014) were screened for patients with and without HD undergoing delivery. HD subtypes included cardiomyopathy (CDM), congenital heart disease, valvular heart disease, and pulmonary hypertension. Rates and reasons of 42-day readmission were determined using weighted national estimates. Independent predictors of postpartum MACCE were determined using multivariable logistic regression for complex survey data. We found among 15,273,247 patients hospitalized for delivery, 33,827 had HD (CDM 22.78%, congenital heart disease 45.98%, valvular heart disease 24.81%, and pulmonary hypertension 6.41%). Of these, 5.2% of HD patients and 1.4% of No HD were readmitted. MACCE was higher in HD vs No HD (2.68% vs 0.17%, p <0.0001). Median time to MACCE was 5.6 days (interquartile range 3 to 15 days). CDM had >10% readmission at 42 days. Among HD patients, cardiovascular, infectious, hypertensive syndromes, and complications of pregnancy were the most common reasons for 42-day readmission. MACCE predictors in women with HD included HD subtype, age, insurance status, obesity, eclampsia, postpartum hemorrhage, MACCE during delivery, preterm delivery, and thrombotic complications. In conclusion, among a nationwide analysis, postpartum MACCE was more common among patients with HD especially within 1 week of discharge from delivery. Predictors can be easily screened for by clinicians, including presence of any HD, hypertensive syndromes, age, obesity, and obstetrical events during index hospitalization.
美国患有心脏病（HD）的女性产后主要不良心脑血管事件（MACCE）的产后数据有限。因此，我们旨在确定美国 MACCE 的患病率和预测因素。从 2010 年至 2014 年的全国再入院数据库中筛选出患有和不患有 HD 并分娩的患者。HD 亚型包括心肌病（CDM）、先天性心脏病、瓣膜性心脏病和肺动脉高压。使用加权全国估计值确定 42 天再入院的发生率和原因。使用多变量逻辑回归对复杂调查数据确定产后 MACCE 的独立预测因素。我们发现，在 15273247 名因分娩住院的患者中，有 33827 名患有 HD（CDM 占 22.78%，先天性心脏病占 45.98%，瓣膜性心脏病占 24.81%，肺动脉高压占 6.41%）。其中，HD 患者中有 5.2%和无 HD 患者中有 1.4%再次入院。HD 患者的 MACCE 发生率高于无 HD 患者（2.68%比 0.17%，p<0.0001）。MACCE 的中位时间为 5.6 天（四分位间距 3 至 15 天）。CDM 在 42 天时的再入院率超过 10%。在 HD 患者中，心血管疾病、感染、高血压综合征和妊娠并发症是 42 天再入院的最常见原因。HD 患者中 MACCE 的预测因素包括 HD 亚型、年龄、保险状况、肥胖、子痫前期、产后出血、分娩期间的 MACCE、早产和血栓并发症。总之，在全国性分析中，产后 MACCE 在 HD 患者中更为常见，尤其是在分娩出院后 1 周内。临床医生可以轻松筛查出预测因素，包括任何 HD、高血压综合征、年龄、肥胖和指数住院期间的产科事件。
