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; William Anthony Parsonage; Joerg 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; W. R. Davidson; 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; E. Pare; N. Khatri; N. Scott; D. De Faria-Yeh; A. B. Bhatt; S. Tsiaras; M. Gurvitz; C. Otto; J. Botti; J. Ting

doi:10.1136/heartjnl-2017-311910

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, William Anthony Parsonage, Joerg SteinUri 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, W. R. Davidson, 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, E. Pare, N. Khatri, N. Scott, D. De Faria-Yeh, A. B. Bhatt, S. Tsiaras, M. Gurvitz, C. Otto, J. Botti, J. Ting

Obstetrics & Gynecology

Research output: Contribution to journal › Article › peer-review

9 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 language	English (US)
Pages (from-to)	745-752
Number of pages	8
Journal	Heart
Volume	104
Issue number	9
DOIs	https://doi.org/10.1136/heartjnl-2017-311910
State	Published - May 1 2018

Keywords

congenital heart disease
global health
heart failure
pregnancy
valvular heart disease

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1136/heartjnl-2017-311910

Cite this

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., Parsonage, W. A., ... Ting, J. (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

Van Hagen, IM, Baart, S, Fong Soe Khioe, R, Sliwa-Hahnle, K, Taha, N, Lelonek, M, Tavazzi, L, Maggioni, AP, Johnson, MR, Maniadakis, N, Fordham, R, Hall, R, Roos-Hesselink, JW, Ferrari, R, Marelli, A, Webb, G, Kaemmerer, H, Popelova, J, Parsonage, WA, Stein, J, Elkayam, U, Thilen, U, Budts, W, Ruys, T, Vardas, P, Komajda, M, Pinto, F, Alonso, A, Wood, D, Ferreira, T, Gracia, G, Laroche, C, Missiamenou, V, Taylor, C, Konte, M, Andarala, M, Fiorucci, E, Lefrancq, EF, Glémot, M, McNeill, PA, Pommier, C, Lafay, M, Aquieri, A, Vega, HR, Blanco, MV, Lust, K, Fagermo, N, Davidson, WR, Gabriel, H, Donhauser, E, Gasimov, Z, Jahangirov, T, Hasanova, I, De Backer, J, Demulier, L, de Hosson, M, Beckx, M, Moissens, M, Kovacevic-Preradovic, T, Kozic, M, Lovric, M, Freire, CV, Chilingirova, N, Kratunkov, P, Montesclaros, AR, Beaubien, E, Gordon, E, Walter, L, Lindsay, C, Wahab, N, Vavera, Z, El Nagar, A, Ebaid, HH, El Sayed Makled, WA, Dardier, A, Shabaan, M, Elrakshy, Y, Eltamawey, K, Abd-El Aziz, MG, Saad, A, Aboleineen, W, Ashour, Z, Sorour, K, Mahdy, MAM, Iserin, L, Ladouceur, M, Cohen, S, Iung, B, Maisuradze, D, Mebus, S, Gembruch, U, Hammerstingl, C, Merz, WM, Wald, C, Baumgartner, H, Orwat, S, Schmidt, R, Motz, R, Olsson, A, Berger, F, Nagdyman, N, Frogoudaki, A, Anastasiou-Nana, M, Temesvari, A, Kohalmi, D, Balint, H, Merkely, B, Liptai, C, Bowen, M, Cullen, M, Thornton, P, Husarova, V, Blatt, A, Elbaz-Greener, G, Moravsky, G, Vered, Z, Fuhrmann, AV, Shotan, A, Goland, S, Festa, P, Ali, LA, Sinagra, G, Puggia, I, Mottolese, BDA, Carmina, MG, Romeo, C, Crepaz, R, Fesslova, V, Azzarelli, A, Baldi, D, Bovenzi, F, Donvito, V, Vasario, E, Todros, T, Niwa, K, Mussagaliyeva, A, Mekebekova, D, Sharipova, S, Zaliunas, R, Jonkaitiene, R, Petrauskaite, J, Gumbiene, L, Jovanova, S, Cassar, A, Caruana, M, Karamermer, Y, Cornette, JMJ, van Dijk, A, Bellersen, L, Duijnhouwer, T, De Groot, C, Pieper, EPG, van Oppen, C, Polak, P, Wajon, E, Wagenaar, L, Estensen, M, Lesniak-Sobelga, A, Podolec, P, Wisniowska-Smialek, S, Trybuch, A, Hoffman, P, Cichocka-Radwan, A, Sobczak, S, Faflik, U, Tomaszuk-Kazberuk, A, Przepiesc, J, Gil, M, Plaskota, K, Trojnarska, O, Guerra, N, de Sousa, L, Petrescu, V, Ginghina, C, Jurcut, R, Coman, IM, Gaisin, IR, Shilina, LV, Sharashkina, N, Tkacheva, O, Ivanov, D, Irtyuga, O, Jovovic, L, Prokselj, K, Kozelj, M, Elliott, C, Galian-Gay, L, Pijuan-Domenech, A, Subirana-Domenech, MT, Tornos, P, Murga, N, Oliver, JM, Escribano-Subías, P, Ruiz-Cano, MJ, Delgado-Jiménez, J, Furenas, E, Dellborg, M, Thilén, U, Schwerzmann, M, Bouchardy, J, Rutz, T, Tobler, D, Sarac, L, Esen, OB, Enar, SC, Al Mulla, A, Bazargani, N, Al Hatou, E, Farook, F, Almahmeed, W, Salih, B, Clifford, P, Bowers, N, Veldtman, G, Kerr, J, Tellett, L, Hudsmith, L, Thompson, P, Thorne, S, Bowater, S, Nihoyannopoulos, P, Curry, R, Freeman, L, Schroeder, F, Wendler, R, Hammond, S, Talluto, C, Murphy, D, Perlroth, MG, Chintala, K, Gupta, P, Pare, E, Khatri, N, Scott, N, De Faria-Yeh, D, Bhatt, AB, Tsiaras, S, Gurvitz, M, Otto, C, Botti, J & Ting, J 2018, 'Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease', Heart, vol. 104, no. 9, pp. 745-752. https://doi.org/10.1136/heartjnl-2017-311910

@article{7b4fa6ba9f3849ca9616b34f7cf8470f,

title = "Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease",

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.",

keywords = "congenital heart disease, global health, heart failure, pregnancy, valvular heart disease",

author = "{Van Hagen}, {Iris M.} and Sara Baart and {Fong Soe Khioe}, Rebekah and Karen Sliwa-Hahnle and Nasser Taha and Malgorzata Lelonek and Luigi Tavazzi and Maggioni, {Aldo Pietro} and Johnson, {Mark R.} and Nikolaos Maniadakis and Richard Fordham and Roger Hall and Roos-Hesselink, {Jolien W.} and Roberto Ferrari and Ariane Marelli and Gary Webb and Harald Kaemmerer and Jana Popelova and Parsonage, {William Anthony} and Joerg Stein and Uri Elkayam and Ulf Thilen and Werner Budts and Titia Ruys and Panos Vardas and Michel Komajda and Fausto Pinto and Angeles Alonso and David Wood and Thierry Ferreira and G{\'e}rard Gracia and C{\'e}cile Laroche and Viviane Missiamenou and Charles Taylor and Mar{\`e}me Konte and Maryna Andarala and Emanuela Fiorucci and Lefrancq, {Elin Folkesson} and Myriam Gl{\'e}mot and McNeill, {Patti Ann} and Caroline Pommier and Myriam Lafay and A. Aquieri and Vega, {H. Ruda} and Blanco, {M. V{\'a}zquez} and K. Lust and N. Fagermo and Davidson, {W. R.} and H. Gabriel and E. Donhauser and Z. Gasimov and T. Jahangirov and I. Hasanova and {De Backer}, J. and L. Demulier and {de Hosson}, M. and M. Beckx and M. Moissens and T. Kovacevic-Preradovic and M. Kozic and M. Lovric and Freire, {C. Vilas} and N. Chilingirova and P. Kratunkov and Montesclaros, {A. R.} and E. Beaubien and E. Gordon and L. Walter and C. Lindsay and N. Wahab and Z. Vavera and {El Nagar}, A. and Ebaid, {H. H.} and {El Sayed Makled}, {W. A.} and A. Dardier and M. Shabaan and Y. Elrakshy and K. Eltamawey and {Abd-El Aziz}, {M. Gamal} and A. Saad and W. Aboleineen and Z. Ashour and K. Sorour and Mahdy, {M. A.Meguid} and L. Iserin and M. Ladouceur and S. Cohen and B. Iung and D. Maisuradze and S. Mebus and U. Gembruch and C. Hammerstingl and Merz, {W. M.} and C. Wald and H. Baumgartner and S. Orwat and R. Schmidt and R. Motz and A. Olsson and F. Berger and N. Nagdyman and A. Frogoudaki and M. Anastasiou-Nana and A. Temesvari and D. Kohalmi and H. Balint and B. Merkely and C. Liptai and M. Bowen and M. Cullen and P. Thornton and V. Husarova and A. Blatt and G. Elbaz-Greener and G. Moravsky and Z. Vered and Fuhrmann, {A. Vazan} and A. Shotan and S. Goland and P. Festa and Ali, {L. Ait} and G. Sinagra and I. Puggia and Mottolese, {B. D.Agata} and Carmina, {M. G.} and C. Romeo and R. Crepaz and V. Fesslova and A. Azzarelli and D. Baldi and F. Bovenzi and V. Donvito and E. Vasario and T. Todros and K. Niwa and A. Mussagaliyeva and D. Mekebekova and S. Sharipova and R. Zaliunas and R. Jonkaitiene and J. Petrauskaite and L. Gumbiene and S. Jovanova and A. Cassar and M. Caruana and Y. Karamermer and Cornette, {J. M.J.} and {van Dijk}, A. and L. Bellersen and T. Duijnhouwer and {De Groot}, C. and Pieper, {E. P.G.} and {van Oppen}, C. and P. Polak and E. Wajon and L. Wagenaar and M. Estensen and A. Lesniak-Sobelga and P. Podolec and S. Wisniowska-Smialek and A. Trybuch and P. Hoffman and A. Cichocka-Radwan and S. Sobczak and U. Faflik and A. Tomaszuk-Kazberuk and J. Przepiesc and M. Gil and K. Plaskota and O. Trojnarska and N. Guerra and {de Sousa}, L. and V. Petrescu and C. Ginghina and R. Jurcut and Coman, {I. Mircea} and Gaisin, {I. Ravilevich} and Shilina, {L. Valeryevna} and N. Sharashkina and O. Tkacheva and D. Ivanov and O. Irtyuga and L. Jovovic and K. Prokselj and M. Kozelj and C. Elliott and L. Galian-Gay and A. Pijuan-Domenech and Subirana-Domenech, {M. T.} and P. Tornos and N. Murga and Oliver, {J. M.} and P. Escribano-Sub{\'i}as and Ruiz-Cano, {M. J.} and J. Delgado-Jim{\'e}nez and E. Furenas and M. Dellborg and U. Thil{\'e}n and M. Schwerzmann and J. Bouchardy and T. Rutz and D. Tobler and L. Sarac and Esen, {O. Batukan} and Enar, {S. Catirli} and {Al Mulla}, A. and N. Bazargani and {Al Hatou}, E. and F. Farook and W. Almahmeed and B. Salih and P. Clifford and N. Bowers and G. Veldtman and J. Kerr and L. Tellett and L. Hudsmith and P. Thompson and S. Thorne and S. Bowater and P. Nihoyannopoulos and R. Curry and L. Freeman and F. Schroeder and R. Wendler and S. Hammond and C. Talluto and D. Murphy and Perlroth, {M. G.} and K. Chintala and P. Gupta and E. Pare and N. Khatri and N. Scott and {De Faria-Yeh}, D. and Bhatt, {A. B.} and S. Tsiaras and M. Gurvitz and C. Otto and J. Botti and J. Ting",

year = "2018",

month = may,

day = "1",

doi = "10.1136/heartjnl-2017-311910",

language = "English (US)",

volume = "104",

pages = "745--752",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "9",

}

TY - JOUR

T1 - Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

AU - Van Hagen, Iris M.

AU - Baart, Sara

AU - Fong Soe Khioe, Rebekah

AU - Sliwa-Hahnle, Karen

AU - Taha, Nasser

AU - Lelonek, Malgorzata

AU - Tavazzi, Luigi

AU - Maggioni, Aldo Pietro

AU - Johnson, Mark R.

AU - Maniadakis, Nikolaos

AU - Fordham, Richard

AU - Hall, Roger

AU - Roos-Hesselink, Jolien W.

AU - Ferrari, Roberto

AU - Marelli, Ariane

AU - Webb, Gary

AU - Kaemmerer, Harald

AU - Popelova, Jana

AU - Parsonage, William Anthony

AU - Stein, Joerg

AU - Elkayam, Uri

AU - Thilen, Ulf

AU - Budts, Werner

AU - Ruys, Titia

AU - Vardas, Panos

AU - Komajda, Michel

AU - Pinto, Fausto

AU - Alonso, Angeles

AU - Wood, David

AU - Ferreira, Thierry

AU - Gracia, Gérard

AU - Laroche, Cécile

AU - Missiamenou, Viviane

AU - Taylor, Charles

AU - Konte, Marème

AU - Andarala, Maryna

AU - Fiorucci, Emanuela

AU - Lefrancq, Elin Folkesson

AU - Glémot, Myriam

AU - McNeill, Patti Ann

AU - Pommier, Caroline

AU - Lafay, Myriam

AU - Aquieri, A.

AU - Vega, H. Ruda

AU - Blanco, M. Vázquez

AU - Lust, K.

AU - Fagermo, N.

AU - Davidson, W. R.

AU - Gabriel, H.

AU - Donhauser, E.

AU - Gasimov, Z.

AU - Jahangirov, T.

AU - Hasanova, I.

AU - De Backer, J.

AU - Demulier, L.

AU - de Hosson, M.

AU - Beckx, M.

AU - Moissens, M.

AU - Kovacevic-Preradovic, T.

AU - Kozic, M.

AU - Lovric, M.

AU - Freire, C. Vilas

AU - Chilingirova, N.

AU - Kratunkov, P.

AU - Montesclaros, A. R.

AU - Beaubien, E.

AU - Gordon, E.

AU - Walter, L.

AU - Lindsay, C.

AU - Wahab, N.

AU - Vavera, Z.

AU - El Nagar, A.

AU - Ebaid, H. H.

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PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

KW - congenital heart disease

KW - global health

KW - heart failure

KW - pregnancy

KW - valvular heart disease

UR - http://www.scopus.com/inward/record.url?scp=85046451639&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046451639&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2017-311910

DO - 10.1136/heartjnl-2017-311910

M3 - Article

C2 - 29092914

AN - SCOPUS:85046451639

VL - 104

SP - 745

EP - 752

JO - Heart

JF - Heart

SN - 1355-6037

IS - 9

ER -

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

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