The temporal relationship between preeclampsia and heart failure

Importance Hypertensive disorders of pregnancy (e.g., preeclampsia) occur in approximately 8 to 10% of pregnancies in the US. Preeclampsia is a significant risk factor for future cardiovascular disease but in the US there is no universal long-term clinical follow up or screening for these conditions. Objective To determine whether having preeclampsia increases the rate of heart failure at or after delivery across demographics and obstetrics related comorbidities. Design Retrospective cohort study. We examined deliveries between January 1, 2018 and March 31, 2023 and assessed the time to heart failure stratified by preeclampsia status. Index event (T0) was first recorded delivery in time frame. Setting Population based using nationally representative data from electronic health records by Truveta Participants Female. 16 to 50 years of age. First recorded delivery in time frame identified using ICD-9-CM, ICD-10-CM, and SNOMED CT codes for delivery. Exclusion criteria: missing information on sex, race, ethnicity, age; if last contact with the health care system was T0; recent history of related cardiovascular conditions; or congenital heart disease. Exposure Preeclampsia on or before delivery. Main Outcomes and Measures Diagnosis of heart failure (HF) at or after T0. Other measures included were Leonard’s obstetric comorbidity score, age, race, ethnicity, and disability. We used Cox proportional hazards models to assess time till HF. Results 718,166 individuals were included and 14,204 had preeclampsia. After adjusting for obstetric comorbidities, race, ethnicity, age and disability, Black patients had a higher hazard of HF compared to white women (HR 3.48; CI 2.97, 4.06). Black patients with preeclampsia had a higher hazard of HF than white patients without preeclampsia (HR 4.63; CI 1.65, 12.99). Black patients without preeclampsia had a risk of HF similar to other racial groups with preeclampsia. Conclusions and Relevance The risk for HF after preeclampsia was significant and should continue to be explored. Modifiable factors for both preeclampsia and HF which should be a focus include substance use disorder and pregestational diabetes. Regular long term clinical follow up or screening of women with preeclampsia for HF may be warranted. Key Points Question Does having preeclampsia increase the rate of heart failure at or after delivery across demographics and obstetrics related comorbidities? Findings In this retrospective cohort study that included 718,166 deliveries, the risk of heart failure at any point after delivery was 2.82 times greater in women that had preeclampsia than those that did not, after controlling for obstetric comorbidities, race, ethnicity, and age. Meaning Regular long term clinical follow up or screening of women with preeclampsia for heart failure may be warranted.