Short-term risk of cardiovascular readmission following a hypertensive disorder of pregnancy. Issue 14 (11th January 2018)

• Record Type: Journal Article
• Authors: Jarvie, Jennifer L; Metz, Torri D; Davis, Melinda B; Ehrig, Jessica C; Kao, David P
• Is Part Of: Heart. Volume 104:Issue 14(2018)
• Page Start: 1187
• Page End: 1194
• Publication Date: 2018-01-11
• Subjects: cardiac risk factors and prevention -- hypertension -- heart disease -- pregnancy; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2017-312299
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Women with pregnancies complicated by hypertensive disorders of pregnancy (HDP) have increased long-term cardiovascular (CV) risk. We sought to determine if they demonstrate increased short-term CV risk. Methods: Using administrative records, all hospital-based deliveries in Florida from 2004 to 2010 and subsequent readmission to any Florida hospital within 3 years of index delivery were identified. Deliveries and clinical diagnoses were determined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. HDP included pregnancies complicated by gestational hypertension, pre-eclampsia or eclampsia. Outcomes were CV readmission (acute myocardial infarction, stroke or heart failure), non-CV readmission and any readmission within 3 years of delivery excluding subsequent deliveries. Associations were determined using multivariate logistic regression. Results: Among 1 452 926 records from delivering mothers of singleton infants (mean age 27.2±6.2 years; 52% white, 23% African American (AA), 18% Hispanic), there were 4054 CV and 259 252 non-CV readmissions. Women with HDP had higher CV readmission rates (6.4 vs 2.5/1000 deliveries; P<0.001). AA women had higher rates of CV readmission than whites or Hispanics (6.8 vs 1.7 vs 1.0/1000 deliveries, respectively; P<0.001). Women with HDP had higher multivariate risk of CV readmission (OR 2.41; 95% CI 2.08 to 2.80) and any readmission (OR 1.13; 95% CI 1.10 to 1.15). Compared with whites, AA women had higher risk for CV readmission (OR 3.60; 95% CI 3.32 to 3.90) after adjustment for HDP. Conclusion: Women with HDP had twice the risk of CV readmission within 3 years of delivery, with higher rates among AA women. More work is needed to explore preventive strategies for HDP-associated events.