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“Clinical outcomes of Peripartum Cardiomyopathy in African American women”
Abstract Number: F 37
Abstract Type: Original Research
Peripartum cardiomyopathy (PPCM) is rare and potentially fatal. The incidence of PPCM is 4-times higher in African American (AA) women than in white women. It is unknown if differences exist in the clinical course or outcomes of African-American women compared to non-African (non-AA) women. We hypothesized that AA women would have worse clinical outcomes than non-AA women.
We performed a multi-institutional retrospective chart review of all pregnant women diagnosed with PPCM at four academic medical centers from 1999 to 2011. Potential cases were identified from billing data using appropriate ICD9-CM codes (674.51, 674.52, 674.53, 674.54, and 674.5). For inclusion, patients needed to meet criteria for PPCM based on NHLBI guidelines: 1) new heart failure (HF) in the last month of pregnancy or within 5 months of delivery, 2) HF without identifiable cause, 3) absence of heart disease prior to the last month of pregnancy, and 4) left ventricular (LV) systolic dysfunction by echocardiography.
Left ventricular ejection fraction was recorded at the time of diagnosis (EF1), hospital discharge (EF2), and approximately 1 year after diagnosis (EF3). The composite outcome measure was maternal death, or severe morbidity defined as heart transplantation, stroke, pulmonary embolus, LV assist device implantation, LV thrombus, and severe end organ failure. The effect of race on EF for each time point was examined using t-test, and categorical variables were compared using the chi-square test.
We identified 171 cases of PPCM; 54 were AA and 118 were non-AA (81% white, 10% Hispanic, 1% Asian, 7% unknown). Baseline clinical characteristics and associated conditions are shown in Table1.
While EF at presentation was not different between the two groups, AA women had lower mean EFs at hospital discharge (31 ± 14 vs. 36 ± 15; p =0.04), and at 1 yr follow up (42 ± 18 vs. 50 ± 14; p =0.01) than non-AA women. AA women also had a higher rate of the composite outcome than non-AA women (32% vs. 18%; p =0.03).
While it is known that AA have a higher incidence of PPCM, our findings suggest that AA also have worse outcomes and a more severe clinical course than non-AA women.