Peripartum cardiomyopathy was associated with an overall all-cause mortality of 8.0% (95% CI 5.5-10.8) at 6 months and 9.8% (95% CI 6.2-14.0) at 12 months across 60 countries.
Meta-Analysis (n=4,875)
Yes
Does guideline-directed heart failure therapy improve left ventricular recovery and reduce mortality in women with peripartum cardiomyopathy?
There are significant global differences in PPCM outcomes, but frequent use of guideline-directed heart failure therapy is associated with better LV recovery and lower mortality.
Aims Peripartum cardiomyopathy (PPCM) remains a major contributor to maternal morbidity and mortality worldwide. The disease is associated with various complications occurring mainly early during its course. Reported adverse outcomes include decompensated heart failure, thromboembolic complications, arrhythmias and death. We sought to systematically and comprehensively review published literature on the management and outcome of women with PPCM across different geographical regions and to identify possible predictors of adverse outcomes. Methods and results We performed a comprehensive search of relevant literature (2000 to June 2021) across a number of electronic databases. Cohort, case‐control and cross‐sectional studies, as well as control arms of randomized controlled trials reporting on 6‐ and/or 12‐month outcomes of PPCM were considered eligible (PROSPERO registration: CRD42021255654). Forty‐seven studies (4875 patients across 60 countries) met the inclusion criteria. Haemodynamic and echocardiographic parameters were similar across all continents. All‐cause mortality was 8.0% (95% confidence interval CI 5.5–10.8, I 2 = 79.1%) at 6 months and 9.8% (95% CI 6.2–14.0, I 2 = 80.5%) at 12 months. All‐cause mortality was highest in Africa and Asia/Pacific. Overall, 44.1% (95% CI 36.1–52.2, I 2 = 91.7%) of patients recovered their left ventricular (LV) function within 6 months and 58.7% (95% CI 48.1–68.9, I 2 = 75.8%) within 12 months. Europe and North America reported the highest prevalence of LV recovery. Frequent prescription of beta‐blocker, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker and bromocriptine/cabergoline were associated with significantly lower all‐cause mortality and better LV recovery. Conclusion We identified significant global differences in 6‐ and 12‐month outcomes in women with PPCM. Frequent prescription of guideline‐directed heart failure therapy was associated with better LV recovery and lower all‐cause mortality. Timely initiation and up‐titration of heart failure therapy should therefore be strongly encouraged to improve outcome in PPCM.
Hoevelmann et al. (2022) conducted a meta-analysis in Peripartum cardiomyopathy (n=4,875). Guideline-directed heart failure therapy was evaluated on All-cause mortality at 6 months (95% CI 5.5-10.8). Peripartum cardiomyopathy was associated with an overall all-cause mortality of 8.0% (95% CI 5.5-10.8) at 6 months and 9.8% (95% CI 6.2-14.0) at 12 months across 60 countries.
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