Epidemiology and outcomes of peripartum cardiomyopathy in the United States

AIMS: Peripartum cardiomyopathy (PPCM) is defined as systolic heart failure within the last month of pregnancy or 5 months after delivery in the absence of any identifiable cause of heart failure. We aimed to investigate the prevalence of PPCM and predictors of in-hospital mortality in patients with PPCM. METHODS: We analyzed patients with diagnosis of PPCM from the Nationwide Inpatient Sample database using the Ninth Revision of International Classification of Diseases (ICD-9) from 2009 to 2010. We categorized PPCM (n = 4871) into three groups of presentation based on their ICD-9 codes: antepartum (674.53; n = 189), peripartum (674.51, 674.52; n = 887) and postpartum (674.54; n = 3741). RESULTS: PPCM was more common in African-Americans (43.9%) as compared with white (40.8%), Hispanic (8.7%) and Asian (2.7%) women. Hypertensive disorders were classified as pre-existing hypertension (31.6%), gestational hypertension (3.7%), preeclampsia (9.9%), eclampsia (2.4%) and preeclampsia/eclampsia superimposed on hypertension (3.1%). Among different ethnicities, pre-existing hypertension (1 : 2.3) and diabetes (1 : 10.4) were more prevalent in African-Americans, whereas preeclampsia (1 : 4.3) and premature labor (1 : 5.4) were more common in Asians. In-hospital mortality rate was 1.8%, with 2.1% in the postpartum and 0.5% in the peripartum group. Asians had the highest mortality (8.3%). In multimodel regression analysis, Asians odds ratio (OR) 9.68, 95% confidence interval (CI) 1.11-83.9, P = 0.03 and length of stay (OR 1.06, 95% CI 1.03-1.10, P < 0.01) were associated with increased mortality, whereas white women were associated with reduced mortality (OR 0.10, 95% CI 0.02-0.59, P = 0.01). CONCLUSION: Although PPCM was prevalent in African-Americans, Asians had higher in-hospital mortality, increased prevalence of preeclampsia and premature labor. Also, mortality rate was significantly higher in the postpartum group.