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Epidemiology and outcomes of peripartum cardiomyopathy in the United States: findings from the Nationwide Inpatient Sample

Krishnamoorthy, Parasurama; Garg, Jalajb; Palaniswamy, Chandrasekarb; Pandey, Ambarishc; Ahmad, Hasanb; Frishman, William H.b; Lanier, Greggb

doi: 10.2459/JCM.0000000000000042
Original article: PDF Only

Aims Peripartum cardiomyopathy (PPCM) is defined as systolic heart failure within the last month of pregnancy or 5 months after delivery in the absence of any identifiable cause of heart failure. We aimed to investigate the prevalence of PPCM and predictors of in-hospital mortality in patients with PPCM.

Methods We analyzed patients with diagnosis of PPCM from the Nationwide Inpatient Sample database using the Ninth Revision of International Classification of Diseases (ICD-9) from 2009 to 2010. We categorized PPCM (n = 4871) into three groups of presentation based on their ICD-9 codes: antepartum (674.53; n = 189), peripartum (674.51, 674.52; n = 887) and postpartum (674.54; n = 3741).

Results PPCM was more common in African-Americans (43.9%) as compared with white (40.8%), Hispanic (8.7%) and Asian (2.7%) women. Hypertensive disorders were classified as pre-existing hypertension (31.6%), gestational hypertension (3.7%), preeclampsia (9.9%), eclampsia (2.4%) and preeclampsia/eclampsia superimposed on hypertension (3.1%). Among different ethnicities, pre-existing hypertension (1 : 2.3) and diabetes (1 : 10.4) were more prevalent in African-Americans, whereas preeclampsia (1 : 4.3) and premature labor (1 : 5.4) were more common in Asians. In-hospital mortality rate was 1.8%, with 2.1% in the postpartum and 0.5% in the peripartum group. Asians had the highest mortality (8.3%). In multimodel regression analysis, Asians [odds ratio (OR) 9.68, 95% confidence interval (CI) 1.11–83.9, P = 0.03] and length of stay (OR 1.06, 95% CI 1.03–1.10, P < 0.01) were associated with increased mortality, whereas white women were associated with reduced mortality (OR 0.10, 95% CI 0.02–0.59, P = 0.01).

Conclusion Although PPCM was prevalent in African-Americans, Asians had higher in-hospital mortality, increased prevalence of preeclampsia and premature labor. Also, mortality rate was significantly higher in the postpartum group.

aDepartment of Medicine, Englewood Hospital and Medical Center, New Jersey

bDepartment of Internal Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, New York

cDepartment of Medicine, Division of Cardiology, University of Texas, Texas, USA

Correspondence to Parasuram Krishnamoorthy, MD, Department of Internal Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07631, USATel: +1 732 501 5100; fax: +1 201 894 0839; e-mail:

Received 19 April, 2014

Revised 26 June, 2014

Accepted 3 September, 2014

© 2018 Italian Federation of Cardiology. All rights reserved.