Bolakale-Rufai Ikeoluwapo Kendra, Knapp Shannon M, Tucker Edmonds Brownsyne, Khan Sadiya, Brewer LaPrincess C, Mohammed Selma, Johnson Amber, Mazimba Sula, Addison Daniel, Breathett Khadijah
Department of Internal Medicine (I.K.B.-R.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Cardiovascular Medicine (S.M.K., K.B.), Indiana University, Indianapolis.
Circ Cardiovasc Qual Outcomes. 2025 Jan;18(1):e011643. doi: 10.1161/CIRCOUTCOMES.124.011643. Epub 2024 Nov 11.
It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E.
Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year.
Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21-0.46]; <0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60-1.67]; =0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (<0.001) but not the remainder of the year (=0.56).
Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.
子痫前期/子痫（PrE/E）患者分娩前的心脏病护理是否与未来发生重大不良心血管事件（MACE）的风险相关尚不清楚。我们试图确定按种族划分的MACE累积发病率，以及PrE/E的黑人和白人患者分娩前的心脏病护理是否与分娩后1年内MACE的风险相关。
利用Optum的去识别化临床信息数据集市数据库，我们确定了2008年至2019年间分娩的PrE/E黑人和白人患者。MACE被定义为心力衰竭、急性心肌梗死、中风和死亡的综合情况。累积发病率函数用于比较不同种族的MACE发病率。回归模型用于评估每个种族因心脏病护理导致的MACE风险。分别计算了前14天和当年剩余时间的风险。
在29336例PrE/E患者（83.4%为白人患者，16.6%为黑人患者，99.5%为商业保险患者，平均年龄：30.9岁）中，11.2%接受了心脏病护理（10.9%为白人患者，13.0%为黑人患者）。黑人患者在分娩后1年的MACE发病率高于白人患者（2.7%对1.4%），大多数发生在分娩后14天内（黑人患者：58.7%；白人患者：67.8%）。在调整年龄和合并症后，分娩后14天内接受心脏病护理与白人患者较低的MACE风险相关（风险比，0.31[95%CI，0.21 - 0.46]；<0.001），但与黑人患者无关（风险比，1.00[95%CI，0.60 - 1.67]；=0.999）。种族与心脏病护理之间的相互作用在最初14天内具有显著意义（<0.001），但在当年剩余时间内无显著意义（=0.56）。
在PrE/E的保险良好的患者群体中，黑人患者在分娩后一年内MACE的累积发病率较高。心脏病护理仅在分娩后的前14天与白人患者较低的MACE风险相关。
