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Heart Failure in Late Pregnancy and Postpartum: Incidence and Long-Term Mortality in Sweden From 1997 to 2010

Journal article
Authors Anders Barasa
Annika Rosengren
Tatiana Zverkova Sandström
Lars Ladfors
Maria Schaufelberger
Published in Journal of Cardiac Failure
Volume 23
Issue 5
Pages 370-378
ISSN 1071-9164
Publication year 2017
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 370-378
Language en
Links https://doi.org/10.1016/j.cardfail....
Keywords Cardiomyopathy, epidemiology, heart failure, pregnancy, postpartum, peripartum cardiomyopathy, racial-differences, outcomes, preeclampsia, predictors, management, diagnosis, prognosis, statement, Cardiovascular System & Cardiology
Subject categories Epidemiology, Cardiovascular medicine

Abstract

Background: Heart failure (HF) in late pregnancy and postpartum (HFPP), of which peripartum cardiomyopathy (PPCM) constitutes the larger part, is still a rare occurrence in Sweden. Population-based data are scarce. Our aim was to characterize HFPP and determine the incidence and mortality in a Swedish cohort. Methods and Results: Through merging data from the National Inpatient, Cause of Death, and Medical Birth Registries, we identified ICD-10 codes for HF and cardiomyopathy within 3 months before delivery to 6 months postpartum. Each case was assigned 5 age -matched control subjects from the Medical Birth Registry. From 1997 to 2010, 241 unique HFPP case subjects and 1063 matched control subjects were identified. Mean incidence was 1 in 5719 deliveries. HFPP was strongly associated with preeclampsia (odds ratio [OR] 11.91, 95% confidence interval [CI] 7.86-18.06), obesity (OR 2.5, 95% CI 1.7-3.7), low-and middle -income country (LMIC) of origin (OR 1.73, 95% CI 1.14-2.63), and twin deliveries (OR 4.39 CI 95% 2.24-8.58). By the end of the study period deaths among cases were > 35 -fold those of controls: 9 cases (3.7 %) and 1 control (0.1 %; P <.0001). Among control subjects, 17.9% of mortalities occurred within 3 years, of diagnosis compared with 100% among cases. Conclusions: The mean incidence and mortality among women with HFPP in Sweden from 1997 to 2010 was low but carried a marked excess risk of death compared with control subjects and was strongly linked to preeclampsia, obesity, multifetal births, and LMIC origin of the mother. (J Cardiac Fail 2017;23:370-378)

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