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Multicenter Study
. 2021 Dec 7;78(23):2281-2290.
doi: 10.1016/j.jacc.2021.09.1360.

Preeclampsia Predicts Risk of Hospitalization for Heart Failure With Preserved Ejection Fraction

Dominique Williams  1 , Molly J Stout  2 , Joshua I Rosenbloom  3 , Margaret A Olsen  4 , Karen E Joynt Maddox  1 , Elena Deych  1 , Victor G Davila-Roman  1 , Kathryn J Lindley  5
Affiliations
Multicenter Study

Preeclampsia Predicts Risk of Hospitalization for Heart Failure With Preserved Ejection Fraction

Dominique Williams et al. J Am Coll Cardiol. .

Abstract

Background: Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established.

Objectives: The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia.

Methods: A retrospective cohort study using the New York and Florida state Healthcare Cost and Utilization Project State Inpatient Databases identified delivery hospitalizations between 2006 and 2014 for women with and without preeclampsia/eclampsia. The authors identified women admitted for HF after discharge from index delivery hospitalization until September 30, 2015, using International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes. Patients were followed from discharge to the first instance of primary outcome (HFpEF hospitalization), death, or end of study period. Secondary outcomes included hospitalization for any HF and HF with reduced ejection fraction, separately. The association between preeclampsia/eclampsia and HFpEF was analyzed using Cox proportional hazards models.

Results: There were 2,532,515 women included in the study: 2,404,486 without and 128,029 with preeclampsia/eclampsia. HFpEF hospitalization was significantly more likely among women with preeclampsia/eclampsia, after adjusting for baseline hypertension and other covariates (aHR: 2.09; 95% CI: 1.80-2.44). Median time to onset of HFpEF was 32.2 months (interquartile range: 0.3-65.0 months), and median age at HFpEF onset was 34.0 years (interquartile range: 29.0-39.0 years). Both traditional (hypertension, diabetes mellitus) and sociodemographic (Black race, rurality, low income) risk factors were also associated with HFpEF and secondary outcomes.

Conclusions: Preeclampsia/eclampsia is an independent risk factor for future hospitalizations for HFpEF.

Keywords: HFpEF; heart failure; preeclampsia; pregnancy; women.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the National Institutes of Health, by grant number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ), and by The Longer Life Foundation Grant # 2020-005. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Attrition Diagram.
The above algorithm was used to arrive at the final population included in this analysis. NY – New York, FL – Florida, SID – State Inpatient Database, SLE - Systemic Lupus Erythematosus, CKD – Chronic Kidney Disease, PPCM – peripartum cardiomyopathy, Q3 – third quarter
Central Illustration.
Central Illustration.. Heart Failure Hospitalizations Following Delivery Complicated by Preeclampsia/Eclampsia.
Kaplan-Meier curves for rehospitalizations for heart failure with reduced ejection fraction (A) following delivery within the first 90 days and between 90 days and 10 years postpartum. Kaplan-Meier curve for rehospitalizations for heart failure with preserved ejection fraction following delivery (B). Kaplan-Meier curves for any heart failure rehospitalization (C) within the first 90 days and between 90 days and 10 years postpartum.
See this image and copyright information in PMC

Comment in

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