Long‐Term Cardiovascular Outcomes After Pregnancy in Women With Heart Disease

BACKGROUND: Women with heart disease are at risk for pregnancy complications, but their long‐term cardiovascular outcomes after pregnancy are not known. METHODS AND RESULTS: We examined long‐term cardiovascular outcomes after pregnancy in 1014 consecutive women with heart disease and a matched group of 2028 women without heart disease. The primary outcome was a composite of mortality, heart failure, atrial fibrillation, stroke, myocardial infarction, or arrhythmia. Secondary outcomes included cardiac procedures and new hypertension or diabetes mellitus. We compared the rates of these outcomes between women with and without heart disease and adjusted for maternal and pregnancy characteristics. We also determined if pregnancy risk prediction tools (CARPREG [Canadian Cardiac Disease in Pregnancy] and World Health Organization) could stratify long‐term risks. At 20‐year follow‐up, a primary outcome occurred in 33.1% of women with heart disease, compared with 2.1% of women without heart disease. Thirty‐one percent of women with heart disease required a cardiac procedure. The primary outcome (adjusted hazard ratio, 19.6; 95% CI, 13.8–29.0; P<0.0001) and new hypertension or diabetes mellitus (adjusted hazard ratio, 1.6; 95% CI, 1.4–2.0; P<0.0001) were more frequent in women with heart disease compared with those without. Pregnancy risk prediction tools further stratified the late cardiovascular risks in women with heart disease, a primary outcome occurring in up to 54% of women in the highest pregnancy risk category. CONCLUSIONS: Following pregnancy, women with heart disease are at high risk for adverse long‐term cardiovascular outcomes. Current pregnancy risk prediction tools can identify women at highest risk for long‐term cardiovascular events.