Department of Cardiology, University of Kansas Medical Center, Kansas, KS, USA.
Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA.
Eur Heart J. 2023 Mar 1;44(9):726-737. doi: 10.1093/eurheartj/ehac669.
Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVDs) in pregnant patients are limited. This study aimed to analyse the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the USA.
This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from 1 January 2010, to 31 December 2019. Data analyses were conducted from January to February 2022. Pregnancy-associated hospitalizations were identified. The main outcomes were the prevalence and trend of CVD in pregnant patients. 39 212 104 hospitalized pregnant patients were identified: 4 409 924 with CVD (11.3%) and 34 802 180 without CVD (88.8%). The annual age-adjusted CVD prevalence increased from 9.2% in 2010 to 14.8% in 2019 (P < 0.001). Hypertensive disorder of pregnancy (1069/10 000) was the most common, and aortic dissection (0.1/10 000) was the least common CVD. The trends of all CVD subtypes increased; however, the trend of valvular heart disease decreased. Age-adjusted in-hospital all-cause mortality was 8.2/10 000 in CVD, but its trend decreased from 8.1/10 000 in 2010 to 6.5/10 000 in 2019 (P < 0.001). CVD was associated with 15.51 times higher odds of in-hospital all-cause mortality compared with non-CVD patients [odds ratio (OR): 15.51, 95% confidence interval (CI)13.22-18.20, P < 0.001]. CVD was associated with higher 6-week postpartum readmission (OR: 1.97, 95% CI: 1.95-1.99), myocardial infarction (OR: 3.04, 95% CI: 2.57-3.59), and stroke (OR: 2.66, 95% CI: 2.41-2.94)(P < 0.001 for all).
There is an increasing age-adjusted trend in overall CVD and its subtypes among pregnant patients in the USA from 2010 to 2019. Pregnant patients with CVD had higher odds of in-hospital mortality than those without CVD. However, in-hospital all-cause mortality among patients with and without CVD has decreased over the past 10 years. CVD was associated with higher 6-week postpartum all-cause readmission, myocardial infarction, and stroke rates.
目前关于心血管疾病（CVD）在孕妇中的流行率、趋势和结局的数据有限。本研究旨在分析美国住院孕妇中 CVD 及其亚型的流行率、趋势和结局。
本回顾性基于人群的队列研究使用全国再入院数据库，从 2010 年 1 月 1 日至 2019 年 12 月 31 日期间，确定所有住院孕妇。数据分析于 2022 年 1 月至 2 月进行。确定了与妊娠相关的住院情况。主要结局是孕妇中 CVD 的流行率和趋势。共确定了 39 212 104 名住院孕妇：4409924 名患有 CVD（11.3%）和 34 802 180 名没有 CVD（88.7%）。年龄调整后的 CVD 年流行率从 2010 年的 9.2%上升至 2019 年的 14.8%（P < 0.001）。妊娠高血压疾病（1069/10 000）是最常见的，主动脉夹层（0.1/10 000）是最不常见的 CVD。所有 CVD 亚型的趋势均有所增加；然而，瓣膜性心脏病的趋势有所下降。CVD 的院内全因死亡率为 8.2/10 000，但从 2010 年的 8.1/10 000 下降至 2019 年的 6.5/10 000（P < 0.001）。与非 CVD 患者相比，CVD 患者院内全因死亡率的优势比（OR）为 15.51（95%CI：13.22-18.20，P < 0.001）。CVD 与 6 周产后再入院（OR：1.97，95%CI：1.95-1.99）、心肌梗死（OR：3.04，95%CI：2.57-3.59）和中风（OR：2.66，95%CI：2.41-2.94）的风险增加相关（所有 P < 0.001）。
从 2010 年到 2019 年，美国住院孕妇的整体 CVD 及其亚型的年龄调整趋势呈上升趋势。患有 CVD 的孕妇院内死亡率高于没有 CVD 的孕妇。然而，过去 10 年来，患有和不患有 CVD 的患者的院内全因死亡率均有所下降。CVD 与更高的 6 周产后全因再入院、心肌梗死和中风发生率相关。
