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Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease

OBJECTIVES: Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evalua...

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Autores principales: Schultz, Hayley, Sobhani, Nasim C, Blissett, Sarah, Yogeswaran, Vidhushei, Hong, Jessica, Harris, Ian S, Parikh, Nisha, Gonzalez, Juan, Agarwal, Anushree
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503351/
https://www.ncbi.nlm.nih.gov/pubmed/37709299
http://dx.doi.org/10.1136/openhrt-2023-002430
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author Schultz, Hayley
Sobhani, Nasim C
Blissett, Sarah
Yogeswaran, Vidhushei
Hong, Jessica
Harris, Ian S
Parikh, Nisha
Gonzalez, Juan
Agarwal, Anushree
author_facet Schultz, Hayley
Sobhani, Nasim C
Blissett, Sarah
Yogeswaran, Vidhushei
Hong, Jessica
Harris, Ian S
Parikh, Nisha
Gonzalez, Juan
Agarwal, Anushree
author_sort Schultz, Hayley
collection PubMed
description OBJECTIVES: Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events. STUDY DESIGN: We identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events. RESULTS: Of 117 patients, 19% had 36 late cardiovascular events over a median follow-up of 3.8 years. Annual incidence of any late cardiovascular event was 5.7%. Hazards of late cardiovascular events were significantly higher among those with higher Cardiac Disease in Pregnancy Study (CARPREG) II and Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) risk scores and among patients with prepregnancy New York Heart Association class≥II. C-statistic to predict the late cardiovascular events was highest for ZAHARA (0.7823), followed by CARPREG II (0.6902) and prepregnancy New York Heart Association class≥ II (0.6677). CONCLUSIONS: Currently available risk tools designed for prognostication during the peripartum period can also be used to determine risks of late maternal cardiovascular events among those with CHD. These findings provide important new information for counselling and risk modification.
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spelling pubmed-105033512023-09-16 Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease Schultz, Hayley Sobhani, Nasim C Blissett, Sarah Yogeswaran, Vidhushei Hong, Jessica Harris, Ian S Parikh, Nisha Gonzalez, Juan Agarwal, Anushree Open Heart Congenital Heart Disease OBJECTIVES: Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events. STUDY DESIGN: We identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events. RESULTS: Of 117 patients, 19% had 36 late cardiovascular events over a median follow-up of 3.8 years. Annual incidence of any late cardiovascular event was 5.7%. Hazards of late cardiovascular events were significantly higher among those with higher Cardiac Disease in Pregnancy Study (CARPREG) II and Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) risk scores and among patients with prepregnancy New York Heart Association class≥II. C-statistic to predict the late cardiovascular events was highest for ZAHARA (0.7823), followed by CARPREG II (0.6902) and prepregnancy New York Heart Association class≥ II (0.6677). CONCLUSIONS: Currently available risk tools designed for prognostication during the peripartum period can also be used to determine risks of late maternal cardiovascular events among those with CHD. These findings provide important new information for counselling and risk modification. BMJ Publishing Group 2023-09-13 /pmc/articles/PMC10503351/ /pubmed/37709299 http://dx.doi.org/10.1136/openhrt-2023-002430 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Congenital Heart Disease
Schultz, Hayley
Sobhani, Nasim C
Blissett, Sarah
Yogeswaran, Vidhushei
Hong, Jessica
Harris, Ian S
Parikh, Nisha
Gonzalez, Juan
Agarwal, Anushree
Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
title Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
title_full Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
title_fullStr Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
title_full_unstemmed Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
title_short Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
title_sort cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease
topic Congenital Heart Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503351/
https://www.ncbi.nlm.nih.gov/pubmed/37709299
http://dx.doi.org/10.1136/openhrt-2023-002430
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