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Reducing late maternal death due to cardiovascular disease - A pragmatic pilot study.

Abstract：

BACKGROUND:Late maternal mortality (up-to 1-year postpartum) is poorly reported globally and is commonly due to cardiovascular disease (CVD). We investigated targeted interventions aiming at reducing peripartum heart failure admission and late maternal death. METHODS AND RESULTS:Prospective single-centre study of 269 peripartum women presenting with CVD in pregnancy, or within 6-months postpartum. Both cardiac disease maternity (CDM) Group-I and Group-II were treated by a dedicated cardiac-obstetric team. CDM Group-II received additional interventions: 1. Early (2-6 weeks) postpartum follow-up at the CDM clinic and immediate referral to dedicated CVD specialist clinics. 2. Beta-blocker therapy was continued in women with LVEF<45% while pregnant, or immediately started postpartum. Of 269 consecutive women (mean age 28.6 ± 5.9), 213 presented prepartum, 22% in NYHA groups III-IV and 79% in modified WHO groups III-IV. Patients were diagnosed with congenital heart disease (30%), valvular heart disease (25%) and cardiomyopathy (31%). The groups were similar in age, diagnosis, NYHA, modified WHO, BP and HIV, but Group-II had a higher rate of previously known CVD (p < 0.001) and a lower rate of being nulliparous (p < 0.0005). Of Group-I patients 9 died within the 12-month follow-up period versus one death in Group-II (p = 0.047). Heart failure leading to admission was 32% in Group-I versus 14% in Group-II (p = 0.0008), with Group-II having a higher beta-blocker use peripartum (p = 0.009). Perinatal mortality rate was 22/1000 live births with no differences between groups. CONCLUSION:Early follow-up in a dedicated CDM clinic with targeted pharmacological interventions led to a significant reduction in peripartum heart failure admission and mortality.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Sliwa K,Azibani F,Baard J,Osman A,Zühlke L,Lachmann A,Libhaber E,Chin A,Ntsekhe M,Soma-Pillay P,Johnson MR,Roos-Hesselink J,Anthony J

doi

10.1016/j.ijcard.2018.07.140

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

70-76

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(18)33947-0

journal_volume

272

pub_type

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Reducing late maternal death due to cardiovascular disease - A pragmatic pilot study.