Key result
Bromocriptine is linked to ~53% lower risk of adverse maternal outcomes vs. standard of care.
Why the study?
Does bromocriptine treatment in addition to standard of care improve maternal outcomes in patients with peripartum cardiomyopathy?
Cohort (n=552)
Yes
Does bromocriptine treatment in addition to standard of care improve maternal outcomes in patients with peripartum cardiomyopathy?
Odds Ratio: 0.47 (95% CI 0.31–0.7)
Absolute Event Rate: 22% vs 33%
p-value: p=< 0.001
In patients with peripartum cardiomyopathy, the addition of bromocriptine to standard of care is associated with significantly improved maternal outcomes at 6 months without an increase in thromboembolic events.
Background and Aims Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM. Methods Peripartum cardiomyopathy patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome [death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction (left ventricular ejection fraction < 35%) at 6-month follow-up]. Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for the missing data. Results Among the 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (P = .044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.10–0.83, P = .021]. This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data: OR 0.47, 95% CI 0.31-0.70, P < 0.001). Thromboembolic events were observed in 6.0% of the patients in the bromocriptine group vs. 5.6% in the standard of care group (P = .900). Conclusions Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months.
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Meer et al. (2024) conducted a cohort in Peripartum cardiomyopathy (n=552). Bromocriptine vs. Standard of care was evaluated on Composite of maternal outcome (death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction [LVEF < 35%] at 6-month follow-up) (OR 0.47, 95% CI 0.31-0.70, p=< 0.001). Bromocriptine treatment was associated with a reduced risk of adverse maternal outcomes at 6 months compared to standard of care alone (OR 0.47; 95% CI 0.31-0.70; P<0.001).
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