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Cardiac risk factors and prevention
Original research article
Short-term risk of cardiovascular readmission following a hypertensive disorder of pregnancy
  1. Jennifer L Jarvie1,
  2. Torri D Metz2,3,
  3. Melinda B Davis4,
  4. Jessica C Ehrig2,
  5. David P Kao1
  1. 1Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
  2. 2Department of Obstetrics and Gynecology/Maternal-Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  3. 3Department of Obstetrics and Gynecology/Maternal-Fetal Medicine, Denver Health Medical Center, Denver, Colorado, USA
  4. 4Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jennifer L Jarvie, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; jennifer.jarvie{at}ucdenver.edu

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.

  • cardiac risk factors and prevention
  • hypertension
  • heart disease
  • pregnancy

https://doi.org/10.1136/heartjnl-2017-312299

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    Footnotes

    • Contributors JLJ and DPK conceived and designed the study. DPK obtained the data and JLJ performed the analysis under the guidance of DPK. JLJ, DPK, TDM, MBD and JCE helped interpret the results. JLJ drafted the manuscript and all authors reviewed it critically for important intellectual content. All authors participated in the revisions and approved the final version. No individuals who significantly contributed to this work were excluded as an author.

    • Funding JLJ was supported by a T32 teaching grant (grant number 5T32HL007822). TDM is supported by the National Institute on Child Health and Human Development under award number 5K12HD001271-18. DPK is supported by the Jacqueline’s Research fund from the Jacqueline Marie Leaffer Foundation at the University of Colorado Center for Women’s Health Research and by NIH grant 1K08HL125725.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute of Health.

    • Competing interests None declared.

    • Ethics approval COMIRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.