Cardiomyopathy
Incidence, Mortality, and Racial Differences in Peripartum Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2007.02.092Get rights and content

There are no large population-based studies on the incidence and prognosis of peripartum cardiomyopathy (PC). Between 1996 and 2005, there were 241,497 deliveries within the Southern California Kaiser healthcare system. Among these, we identified 60 cases of PC by searching for an International Classification of Diseases, Ninth Edition diagnosis of heart failure (HF) and detailed chart review. PC was confirmed if all of the following criteria were satisfied: (1) left ventricular ejection fraction <0.50, (2) met the Framingham criteria for HF, (3) new symptoms of HF or initial echocardiographic diagnosis of left ventricular dysfunction occurred in the month before or in the 5 months after delivery, and (4) no alternative cause of HF could be identified. The overall incidence of PC was 1 in 4,025 deliveries. The incidence in whites, African-Americans, Hispanics, and Asians was 1 of 4,075, 1 of 1,421, 1 of 9,861, and 1 of 2,675 deliveries, respectively. The incidence of PC was greatest in African-Americans, which was 2.9-fold higher compared with whites (p = 0.03) and 7-fold that of Hispanics (p <0.001). With a mean follow-up of 4.7 years, the freedom from all-cause death was 96.7% by the Kaplan-Meier method. In conclusion, this large population-based study highlights important racial differences in the incidence of PC. We observed the lowest incidence of PC in Hispanics and the highest in African-Americans. Our findings also suggest that the current mortality associated with PC may be less than reported in older series, perhaps because of the high utilization of modern HF therapy.

Section snippets

Methods and Results

The Peripartum Cardiomyopathy research project is a study designed to determine the incidence, predictors, and outcomes of women with this rare disorder in the Kaiser Permanente Southern California health plan. The region is ethnically diverse with whites, Hispanics, Asians, and African-Americans well represented.

By searching electronic hospitalization databases, we identified all women hospitalized with heart failure (HF) 6 months before or 9 months after a delivery between January 1, 1996 and

Discussion

In this large community-based population the overall incidence of PC was 1 in 4,025 births in the Southern California region, but there was substantial variability between races. The incidence was highest in African-Americans and lowest in Hispanics. The variation in incidence by ethnicity may help explain, in part, the wide range reported in the literature. However, what remains unclear is the reason for these differences. It is possible that environmental or genetic influences may be

References (10)

There are more references available in the full text version of this article.

Cited by (239)

  • Nutritional Heart Disease and Cardiomyopathies: JACC Focus Seminar 4/4

    2023, Journal of the American College of Cardiology
  • Black-White disparity in severe cardiovascular maternal morbidity: A systematic review and meta-analysis

    2022, American Heart Journal
    Citation Excerpt :

    All studies used a retrospective cohort design. Among the included studies, 11 used data from the National Inpatient Sample;8,11,12,14-17,20,22,24,25 2 used data from the Southern California Kaiser Healthcare System;21,26 4 used state-based hospitalization data from one or more of the following states: California, Florida, Michigan, New Hampshire, New Jersey, New York, North Carolina, Vermont, and West Virginia;13,19,27,28 and one study used data from a single hospital in Rhode Island.18 Nearly all studies were conducted in a general pregnancy population, although 3 studies were limited to women with preeclampsia,16 peripartum cardiomyopathy,8 and heart failure.21

  • Obstetric Disorders and Critical Illness

    2022, Clinics in Chest Medicine
View all citing articles on Scopus
View full text