1. Among patients with peripartum cardiomyopathy complicated by cardiogenic shock, there was a higher risk of in-hospital mortality in Black and Hispanic patients compared to White patients, which affirmed racial and ethnic disparities in these populations.
Evidence Rating Level: 2 (Good)
Peripartum cardiomyopathy (PPCM) is heart failure which can begin during the final month of pregnancy through five months postpartum. Mortality from PPCM can often arise secondary to complications such as cardiogenic shock. While studies have shown that the incidence of PPCM is higher amongst Black patients compared to White patients, racial and ethnic disparities in PPCM complicated by cardiogenic shock are unknown. In this multicenter retrospective cohort study, 1945 hospitalized patients with PPCM complicated by cardiogenic shock were assessed for in-hospital mortality, as well as mechanical circulatory support and heart transplantation. Among these selected patients, 48.6% were Black (n=947), 12.1% were Hispanic (n=236), and 39.2% were White (n=762). Compared to White patients, Black and Hispanic patients had a significantly higher risk of in-hospital mortality (aOR 1.67, 95%CI 1.21-2.32, and aOR 2.20, 95%CI 1.45-3.33, respectively). The results additionally show that Hispanic patients had the highest rate of requiring mechanical circulatory support (35.6%), followed by Black patients (21.0%). Other clinical factors associated with increased risk of in-hospital mortality among PPCM patients included chronic kidney disease, diabetes, obesity, and antepartum hemorrhage. In conclusion, the findings of this study are consistent with previous discussions surrounding race and ethnicity in cardiovascular outcomes among pregnant and postpartum patients – a higher risk of mortality exists in Black and Hispanic patients compared to White patients. While this study is limited due to its retrospective nature and reliance on administrative data, it derives information from a large sample of nationally represented data, owing to a high degree of generalizability to the broader US population. Further research investigating factors involved in racial and ethnic disparities among patients with PPCM will be critical in improving health outcomes in this population.
Click to read the study in JAMA Network Open
Image: PD
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