Preterm birth associated with increased risk for heart failure into adulthood
Preterm birth is associated with an increased risk for heart failure into adulthood, according to a study published in JAMA Pediatrics.
The risk is more than 2-fold for people born preterm and more than 12-fold for those born extremely preterm, researchers reported.
For the study, Casey Crump, MD, PhD, vice chair for research in the department of family medicine and community health at the Icahn School of Medicine at Mount Sinai in New York, and colleagues assessed all singleton live births in Sweden from 1973 through 2014.
“Singleton births were chosen for the primary analyses to improve internal comparability, given the higher prevalence of preterm birth and its different underlying causes among multiple births,” the authors wrote.
The researchers included 4,193,069 births in their study, after excluding 8,637 births for missing information on gestational age. The mean age of all individuals at follow-up was 22.5 years.
Among 85 million person-years of follow-up, 4,158 (0.1%) study participants were identified as having heart failure — an overall incidence rate of 4.8 per 100,000 among ages 0 to 43 years, Crump and colleagues reported. The incidence rates per 100,000 person-years were 11.5 among preterm births, 5.8 among those born at an early term, and 4.1 among those born at full term. The median age at time of diagnosis was 15.4 years.
Relative to full term, preterm birth (gestational age less than 37 weeks) was associated with a 2.7-fold (aHR 2.69 [95% CI, 2.43-2.97]) increased risk for heart failure, and early term birth was associated with a 1.4-fold risk (aHR 1.4 [95% CI, 1.29–1.51]), the researchers found. People born extremely preterm (gestational age 22 to 27 weeks) were nearly 13 times more likely to have heart failure (aHR 12.83 [95% CI, 9.55-17.25]).
“Heart failure frequently has a large burden of disease and is associated with high hospitalization rates, health care expenditures, and premature mortality. Our findings suggest that individuals born preterm may need long-term clinical follow-up into adulthood for preventive evaluation and monitoring, even among those without known cardiac abnormalities,” the authors wrote.
In a related editorial, Mandy Brown Belfort, MD, MPH, from Brigham and Women’s Hospital and Harvard Medical School, and Suzanne Brown Sacks, MD, MS, from Vanderbilt University School of Medicine, said that although the study provided answers to some questions, the results elicited more.
“Most importantly for its clinical implications, what is the cause of heart failure as defined by the diagnosis codes used in this study? More specific information about the type of heart failure is needed because right-sided and left-sided heart failure, as well as systolic and diastolic heart failure, have distinct causes and treatments,” they wrote. “Another relevant question is whether the type of heart failure varies by age of presentation. This knowledge could guide screening and management by primary care professionals and specialty health care professionals.”
References:
Belfort MB, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.0138.
Crump C, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.0131.
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