Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality

Abstract

Objective: To estimate the birth prevalence and 7-year case-fatality rate of peripartum cardiomyopathy for a statewide population by applying the National Institutes of Health Workshop on Peripartum Cardiomyopathy definition, including echocardiographic criteria for left ventricular dysfunction.

Methods: This was an epidemiologic study of residents of North Carolina experiencing an obstetric delivery or a pregnancy-related death before delivery in 2002 through 2003 including 235,599 live births. Potential cases were identified from International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM), pregnancy and cardiovascular codes followed by medical record review, and from the state pregnancy-related mortality file. Only women meeting the established definition including echocardiographic criteria for left ventricular dysfunction and women with diagnoses at autopsy were included. The state death file and the U.S. Social Security Death Index were searched for the years 2002 through 2010 for all cases.

Results: A total of 740 potential cases from 70 hospitals were identified from discharge ICD-9-CM codes. The medical records for 698 (94.3%) were located and reviewed. Seventy-eight met inclusion criteria. An additional seven women had diagnoses only at autopsy. The birth prevalence was 1 case for every 2,772 live births or 3.61 cases per 10,000 live births (95% confidence interval 2.88-4.46). The 7-year case-fatality rate was 16.5% (95% confidence interval 10--25.9%). Black non-Hispanic women experienced an almost fourfold increased prevalence and fatality compared with white women. Women older than age 35 years had the highest prevalence.

Conclusions: The racial disparity in both birth prevalence and case-fatality is striking; one in six women died within 7 years.

Level of evidence: II.