Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

Iris M. Van Hagen, Sara Baart, Rebekah Fong Soe Khioe, Karen Sliwa-Hahnle, Nasser Taha, Malgorzata Lelonek, Luigi Tavazzi, Aldo Pietro Maggioni, Mark R. Johnson, Nikolaos Maniadakis, Richard Fordham, Roger Hall, Jolien W. Roos-Hesselink, Roberto Ferrari, Ariane Marelli, Gary Webb, Harald Kaemmerer, Jana Popelova, Karen Sliwa, William Anthony ParsonageJoerg Stein, Uri Elkayam, Ulf Thilen, Werner Budts, Titia Ruys, Panos Vardas, Michel Komajda, Fausto Pinto, Angeles Alonso, David Wood, Thierry Ferreira, Gérard Gracia, Cécile Laroche, Viviane Missiamenou, Charles Taylor, Marème Konte, Maryna Andarala, Emanuela Fiorucci, Elin Folkesson Lefrancq, Myriam Glémot, Patti Ann McNeill, Caroline Pommier, Myriam Lafay, A. Aquieri, H. Ruda Vega, M. Vázquez Blanco, K. Lust, N. Fagermo, H. Gabriel, E. Donhauser, Z. Gasimov, T. Jahangirov, I. Hasanova, J. De Backer, L. Demulier, M. de Hosson, M. Beckx, M. Moissens, T. Kovacevic-Preradovic, M. Kozic, M. Lovric, C. Vilas Freire, N. Chilingirova, P. Kratunkov, A. R. Montesclaros, E. Beaubien, E. Gordon, L. Walter, C. Lindsay, N. Wahab, Z. Vavera, A. El Nagar, H. H. Ebaid, W. A. El Sayed Makled, A. Dardier, M. Shabaan, Y. Elrakshy, K. Eltamawey, M. Gamal Abd-El Aziz, A. Saad, W. Aboleineen, Z. Ashour, K. Sorour, M. A.Meguid Mahdy, L. Iserin, M. Ladouceur, S. Cohen, B. Iung, D. Maisuradze, S. Mebus, U. Gembruch, C. Hammerstingl, W. M. Merz, C. Wald, H. Baumgartner, S. Orwat, R. Schmidt, R. Motz, A. Olsson, F. Berger, N. Nagdyman, A. Frogoudaki, M. Anastasiou-Nana, A. Temesvari, D. Kohalmi, H. Balint, B. Merkely, C. Liptai, M. Bowen, M. Cullen, P. Thornton, V. Husarova, A. Blatt, G. Elbaz-Greener, G. Moravsky, Z. Vered, A. Vazan Fuhrmann, A. Shotan, S. Goland, P. Festa, L. Ait Ali, G. Sinagra, I. Puggia, B. D.Agata Mottolese, M. G. Carmina, C. Romeo, R. Crepaz, V. Fesslova, A. Azzarelli, D. Baldi, F. Bovenzi, V. Donvito, E. Vasario, T. Todros, K. Niwa, A. Mussagaliyeva, D. Mekebekova, S. Sharipova, R. Zaliunas, R. Jonkaitiene, J. Petrauskaite, L. Gumbiene, S. Jovanova, A. Cassar, M. Caruana, Y. Karamermer, J. M.J. Cornette, A. van Dijk, L. Bellersen, T. Duijnhouwer, C. De Groot, E. P.G. Pieper, C. van Oppen, P. Polak, E. Wajon, L. Wagenaar, M. Estensen, A. Lesniak-Sobelga, P. Podolec, S. Wisniowska-Smialek, A. Trybuch, P. Hoffman, A. Cichocka-Radwan, S. Sobczak, U. Faflik, A. Tomaszuk-Kazberuk, J. Przepiesc, M. Gil, K. Plaskota, O. Trojnarska, N. Guerra, L. de Sousa, V. Petrescu, C. Ginghina, R. Jurcut, I. Mircea Coman, I. Ravilevich Gaisin, L. Valeryevna Shilina, N. Sharashkina, O. Tkacheva, D. Ivanov, O. Irtyuga, L. Jovovic, K. Prokselj, M. Kozelj, C. Elliott, L. Galian-Gay, A. Pijuan-Domenech, M. T. Subirana-Domenech, P. Tornos, N. Murga, J. M. Oliver, P. Escribano-Subías, M. J. Ruiz-Cano, J. Delgado-Jiménez, E. Furenas, M. Dellborg, U. Thilén, M. Schwerzmann, J. Bouchardy, T. Rutz, D. Tobler, L. Sarac, O. Batukan Esen, S. Catirli Enar, A. Al Mulla, N. Bazargani, E. Al Hatou, F. Farook, W. Almahmeed, B. Salih, P. Clifford, N. Bowers, G. Veldtman, J. Kerr, L. Tellett, L. Hudsmith, P. Thompson, S. Thorne, S. Bowater, P. Nihoyannopoulos, R. Curry, L. Freeman, F. Schroeder, R. Wendler, S. Hammond, C. Talluto, D. Murphy, M. G. Perlroth, K. Chintala, P. Gupta, Emmanuelle Pare, N. Khatri, N. Scott, D. De Faria-Yeh, A. B. Bhatt, S. Tsiaras, M. Gurvitz, C. Otto, J. Botti, J. Ting, W. R. Davidson

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Objective Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease. Methods The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country). Results A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate. Conclusion While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome.

Original languageEnglish (US)
Pages (from-to)745-752
Number of pages8
JournalHeart
Volume104
Issue number9
DOIs
StatePublished - May 1 2018

Keywords

  • congenital heart disease
  • global health
  • heart failure
  • pregnancy
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Van Hagen, I. M., Baart, S., Fong Soe Khioe, R., Sliwa-Hahnle, K., Taha, N., Lelonek, M., Tavazzi, L., Maggioni, A. P., Johnson, M. R., Maniadakis, N., Fordham, R., Hall, R., Roos-Hesselink, J. W., Ferrari, R., Marelli, A., Webb, G., Kaemmerer, H., Popelova, J., Sliwa, K., ... Davidson, W. R. (2018). Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease. Heart, 104(9), 745-752. https://doi.org/10.1136/heartjnl-2017-311910