TY - JOUR
T1 - Cardiovascular Complications With Delivery Hospitalizations in Patients With Pulmonary Hypertension
T2 - A Nationwide Study From 2011 to 2020
AU - Agrawal, Ankit
AU - Bajaj, Suryansh
AU - Bhagat, Umesh
AU - Yesilyaprak, Abdullah
AU - Chandna, Sanya
AU - Arockiam, Aro Daniela
AU - Jamil, Yasser
AU - Iskandarani, Mahmoud El
AU - Gupta, Rahul
AU - Majid, Muhammad
AU - Nayar, Divya
AU - Michos, Erin D.
N1 - Publisher Copyright:
© 2024 The Authors.
PY - 2024/6/4
Y1 - 2024/6/4
N2 - BACKGROUND: Pregnancy in patients with pulmonary hypertension (PH) is associated with a heightened risk of medical complications including right heart failure, pulmonary edema, and arrhythmias. Our study investigated the association between PH and these complications during delivery. METHODS AND RESULTS: The National Inpatient Sample was used to identify delivery hospitalizations from 2011 to 2020. Multivariable logistic regression was performed to study the association of PH with the primary outcomes of in-hospital medical and obstetric complications. A total of 37 482 207 delivery hospitalizations in women ≥18 years of age were identified, of which 9593 patients had PH. Pregnant patients with PH had higher incidence of complications during delivery including preeclampsia/eclampsia, arrhythmias, and pulmonary edema among others, compared with those without PH. Pregnant patients with PH also had a higher incidence of in-hospital mortality compared with those without PH (0.51% versus 0.007%). In propensity-matched analyses, PH was still significantly associated with a higher risk of in-hospital mortality (odds ratio [OR], 5.02 [95% CI, 1.82–13.90]; P=0.001), pulmonary edema (OR, 9.11 [95% CI, 6.34–13.10]; P<0.001), peripartum cardiomyopathy (OR, 1.85 [95% CI, 1.37–2.50]; P<0.001), venous thromboembolism (OR, 12.60 [95% CI, 6.04–26.10]; P<0.001), cardiac arrhythmias (OR, 6.11 [95% CI, 4.97–7.53]; P<0.001), acute kidney injury (OR, 3.72 [95% CI, 2.86–4.84]; P<0.001), preeclampsia/eclampsia (OR, 2.24 [95% CI, 1.95–2.58]; P<0.001), and acute coronary syndrome (OR, 2.01 [95% CI, 1.06–3.80]; P=0.03), compared with pregnant patients without PH. CONCLUSIONS: Delivery hospitalizations in patients with PH are associated with a high risk of mortality, pulmonary edema, peripartum cardiomyopathy, venous thromboembolism, arrhythmias, acute kidney injury, preeclampsia/eclampsia, and acute coronary syndrome.
AB - BACKGROUND: Pregnancy in patients with pulmonary hypertension (PH) is associated with a heightened risk of medical complications including right heart failure, pulmonary edema, and arrhythmias. Our study investigated the association between PH and these complications during delivery. METHODS AND RESULTS: The National Inpatient Sample was used to identify delivery hospitalizations from 2011 to 2020. Multivariable logistic regression was performed to study the association of PH with the primary outcomes of in-hospital medical and obstetric complications. A total of 37 482 207 delivery hospitalizations in women ≥18 years of age were identified, of which 9593 patients had PH. Pregnant patients with PH had higher incidence of complications during delivery including preeclampsia/eclampsia, arrhythmias, and pulmonary edema among others, compared with those without PH. Pregnant patients with PH also had a higher incidence of in-hospital mortality compared with those without PH (0.51% versus 0.007%). In propensity-matched analyses, PH was still significantly associated with a higher risk of in-hospital mortality (odds ratio [OR], 5.02 [95% CI, 1.82–13.90]; P=0.001), pulmonary edema (OR, 9.11 [95% CI, 6.34–13.10]; P<0.001), peripartum cardiomyopathy (OR, 1.85 [95% CI, 1.37–2.50]; P<0.001), venous thromboembolism (OR, 12.60 [95% CI, 6.04–26.10]; P<0.001), cardiac arrhythmias (OR, 6.11 [95% CI, 4.97–7.53]; P<0.001), acute kidney injury (OR, 3.72 [95% CI, 2.86–4.84]; P<0.001), preeclampsia/eclampsia (OR, 2.24 [95% CI, 1.95–2.58]; P<0.001), and acute coronary syndrome (OR, 2.01 [95% CI, 1.06–3.80]; P=0.03), compared with pregnant patients without PH. CONCLUSIONS: Delivery hospitalizations in patients with PH are associated with a high risk of mortality, pulmonary edema, peripartum cardiomyopathy, venous thromboembolism, arrhythmias, acute kidney injury, preeclampsia/eclampsia, and acute coronary syndrome.
KW - cardiac arrhythmias
KW - congestive heart failure
KW - hypertension, pulmonary
KW - pregnancy
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U2 - 10.1161/JAHA.123.031632
DO - 10.1161/JAHA.123.031632
M3 - Article
C2 - 38804208
AN - SCOPUS:85195008127
SN - 2047-9980
VL - 13
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e031632
ER -