Concomitant peripartum cardiomyopathy, cardiogenic shock yield disparate outcomes by race
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Black and Hispanic patients with peripartum cardiomyopathy exhibited greater prevalence of cardiogenic shock and experienced greater in-hospital mortality vs. white patients, researchers reported.
In addition, mechanical circulatory use and heart transplantation were lower among Black and Hispanic patients with peripartum cardiomyopathy complicated by cardiogenic shock compared with white patients.
Peripartum cardiomyopathy is defined as HF secondary to left ventricular systolic dysfunction 1 month before childbirth or 5 months after childbirth with no identifiable cause in patients without history of structural heart disease, according to the study findings published in JAMA Network Open.
“Mortality rates in peripartum cardiomyopathy range from 7% to 50%, often as a result of complications, such as cardiogenic shock, thromboembolism and arrhythmias,” Titilope Olanipekun, MD, attending physician from the department of hospital medicine in the Covenant Health System in Knoxville, Tennessee, and colleagues wrote. “Cardiogenic shock is reported as a complication among approximately 2% to 4% of patients with peripartum cardiomyopathy, often treated with mechanical circulatory support and heart transplantation and is associated with poor prognosis. Although racial and ethnic disparities in peripartum cardiomyopathy incidence and all-cause mortality risks have been well described, there is limited information on clinical outcomes among patients with peripartum cardiomyopathy complicated by cardiogenic shock.”
Researchers assessed racial/ethnic disparities in peripartum cardiomyopathy complicated by cardiogenic shock using the National Inpatient Sample to identify 55,804 hospitalized patients from 2005 to 2019.
The primary outcome was incidence of cardiogenic shock in the setting of peripartum cardiomyopathy stratified by race/ethnicity. Other outcomes of interest included in-hospital mortality, mechanical circulatory support use and heart transplantation stratified by race/ethnicity.
Incidence of peripartum cardiomyopathy plus cardiogenic shock
A total of 1,945 patients hospitalized for peripartum cardiomyopathy also had cardiogenic shock (mean age, 31 years), conferring an incidence rate of 35 cardiogenic shock events per 1,000 patients with peripartum cardiomyopathy.
Researchers reported that Black and Hispanic patients with peripartum cardiomyopathy experienced a higher rate of cardiogenic shock compared with white patients (39 events per 1,000 patients vs. 33 events per 1,000 patients).
The likelihood of developing cardiogenic shock was higher in Black patients (adjusted OR = 1.17; 95% CI, 1.15-1.57; P < .001) and Hispanic patients (aOR = 1.37; 95% CI, 1.17-1.59; P < .001) with peripartum cardiomyopathy compared with white patients.
Care and outcomes stratified by race/ethnicity
The odds of in-hospital mortality were also higher in both Black (aOR = 1.67; 95% CI, 1.21-2.32; P = .002) and Hispanic patients (aOR = 2.2; 95% CI, 1.45-3.33; P < .001) with peripartum cardiomyopathy complicated by cardiogenic shock compared with white patients.
Although Hispanic patients were more likely to receive any type of mechanical circulatory support, intra-aortic balloon pump and ventricular assist device compared with white patients, researchers noted that Black patients were only more likely to receive VAD (P for all < .001).
Moreover, Black (aOR = 0.51; 95% CI, 0.33-0.78; P = .02) and Hispanic patients (aOR = 0.15; 95% CI, 0.06-0.42; P < .001) were less likely to receive a heart transplant compared with white patients.
“Black and Hispanic patients had a higher prevalence of traditional CVD risk factors, such as diabetes, obesity and hypertensive disorders of pregnancy, compared with white patients. We also found higher mortality odds in the subgroups of Black and Hispanic patients with lower median income, which suggests that low socioeconomic status may have a role to play in the observed poorer outcomes,” Olanipekun told Healio. “Our study findings show that more work still needs to be done to better understand contributory factors to racial disparities observed in our study, which will be essential in guiding interventions targeted at improving outcomes for all patients with peripartum cardiomyopathy.”
For more information:
Titilope Olanipekun, MD, can be reached at toolanipekun@gmail.com.
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