Arrhythmia history linked to adverse pregnancy outcomes

The study authors initiated this study due to a lack of data on arrhythmia trends in pregnant women hospitalized for childbirth, taking into account their age, comorbidities and obesity.

The incidence of pregnancy-related complications was higher in a cohort of pregnant patients hospitalized for delivery who had a history of arrhythmias, and these negative outcomes were influenced by all-cause in-hospital mortality, cardiovascular disease, and adverse outcomes. pregnancy outcomes.

Research results published in Frontiers in cardiovascular medicine also exhibit negative outcomes are more likely in this patient subgroup when they are older than 35 years, classified as obese, and have hypertension, valvular heart disease, or severe lung disease, as they are more likely to also have a history of arrhythmias or a childbirth-induced arrhythmia .

“While many cardiac arrhythmias in pregnancy are considered benign, there is also limited data suggesting an association with in-hospital death,” the study authors wrote. “There is also little data associating cardiac arrhythmias with comorbidities and risk factors.”

Data on childbirth hospitalizations from 2009 to 2019 from the National Inpatient Sample (NIS) database were used for this analysis, and International Classification of Diseases, 9th Edition and 10th edition codes identifying supraventricular tachycardia (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation. More than 41 million hospital admissions were analysed.

SVTs were the most common arrhythmia (53%), followed by AF (31%) and VT (13%). The authors identified several factors associated with a possible link between childbirth complications and an increased risk of arrhythmias, and they were as follows:

  • Valvular disease, which had an 11.77 times greater risk of leading to arrhythmias (odds ratio [OR], 12.77; 95% C1, 1.98-13.61)
  • Heart failure, with a 6.1 times greater associated risk (OR, 7.13; 95% CI, 6.49-7.83)
  • Previous myocardial infarction (MI), 4.41 times greater risk (OR, 5.41; 95% CI, 4.01-7.30)
  • Peripheral vascular disease (PVD), 2.19 times greater risk (OR, 3.19; 95% CI, 2.51-4.06)
  • Hypertension, 1.18 times greater risk (OR, 2.18; 95% CI, 2.07-2.28)
  • Obesity, 0.69 times greater risk (OR, 1.69; 95% CI, 1.63-1.76).

In addition, arrhythmia-complicated hospital deliveries had higher rates of all-cause mortality, need for cardiogenic shock, preeclampsia, and preterm birth compared to women who did not have arrhythmias (all P < .0001):

  • In-hospital death from all causes: 0.95% vs. 0.01%

  • Need for cardiogenic shock: 0.48% vs. 0.00%

  • Preeclampsia: 6.96% vs. 3.58%

  • Premature Birth: 2.95% vs. 2.41%

Childbirth outcomes associated with arrhythmias may also have been linked to older age, race/ethnicity, rural versus urban location, and insurance status:

  • Women ages 31 to 35, 36 to 40, and 41 to 45 were more likely to have adverse pregnancy outcomes if arrhythmias were present versus women without arrhythmias: 26.58% vs 23.71%, 15.15% vs 10.86 % and 4.27% versus 2.07% respectively
  • White patients were most likely to have adverse pregnancy outcomes accompanied by arrhythmias versus those without arrhythmias (60.13% versus 52.82%) compared with black patients who had or did not have arrhythmias (20.44% versus 14.77%), Latin -US patients (11.35% vs. 21.13%) and Asian patients (3.94% vs. 5.76%)

Arrhythmia-complicated deliveries versus women without arrhythmias were also more than twice as likely if patients had these risk factors: obesity (16.95% vs. 8.31%), hypertension (6.19% vs. 1.53%), diabetes type 2 (1.39% vs. 0.64%), MI history (0.22% vs. 0.01%), PVD (0.23% vs. 0.01%), and hyperlipidemia (0.35% vs. 0.01%). 06%).

Risk-taking behavior was also more common among the women with arrhythmias, including tobacco use and substance abuse. Presence of comorbidities was also more common in women with arrhythmias, with the top 3 being chronic obstructive pulmonary disease, fluid and electrolyte disturbances and coagulopathy, respectively.

“These findings build on previously published studies, all of which have shown an increased frequency of arrhythmias in pregnant women since the 1990s. The measured increase in the prevalence of arrhythmias during pregnancy is likely multifactorial,” the study authors wrote. “While the increased prevalence may be due in part to an increase in risk factors, such an increase may also be due use of electronic health records, remote monitoring and general shifts in monitoring and record keeping practices.”

They emphasized the importance of multidisciplinary care and preventive cardiology prevention in women with known cardiovascular disease or who may be at higher risk for it, with cardio-obstetric care known to reduce cardiac maternal morbidity.

“Arrhythmia should be treated at every stage of pregnancy,” they concluded, “from prevention to early recognition of complications during childbirth.”

Reference

Thakkar A, Kwapong YA, Patel H, et al. Temporal trends of arrhythmias in childbirth hospitalizations in the United States: analysis of the National Inpatient Sample, 2009-2019. Front Cardiovascular Med. Published online November 3, 2022. doi:10.3389/fcvm.2022.1000298

Arrhythmia history linked to adverse pregnancy outcomes

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