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 | |
| 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
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Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease. / Van Hagen, Iris M.; Baart, Sara; Fong Soe Khioe, Rebekah; Sliwa-Hahnle, Karen; Taha, Nasser; Lelonek, Malgorzata; Tavazzi, Luigi; Maggioni, Aldo Pietro; Johnson, Mark R.; Maniadakis, Nikolaos; Fordham, Richard; Hall, Roger; Roos-Hesselink, Jolien W.; Ferrari, Roberto; Marelli, Ariane; Webb, Gary; Kaemmerer, Harald; Popelova, Jana; Sliwa, Karen; Parsonage, William Anthony; Stein, Joerg; Elkayam, Uri; Thilen, Ulf; Budts, Werner; Ruys, Titia; Vardas, Panos; Komajda, Michel; Pinto, Fausto; Alonso, Angeles; Wood, David; Ferreira, Thierry; Gracia, Gérard; Laroche, Cécile; Missiamenou, Viviane; Taylor, Charles; Konte, Marème; Andarala, Maryna; Fiorucci, Emanuela; Lefrancq, Elin Folkesson; Glémot, Myriam; McNeill, Patti Ann; Pommier, Caroline; Lafay, Myriam; Aquieri, A.; Vega, H. Ruda; Blanco, M. Vázquez; Lust, K.; Fagermo, N.; 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, C. Vilas; Chilingirova, N.; Kratunkov, P.; Montesclaros, A. R.; Beaubien, E.; Gordon, E.; Walter, L.; Lindsay, C.; Wahab, N.; Vavera, Z.; El Nagar, A.; Ebaid, H. H.; El Sayed Makled, W. A.; Dardier, A.; Shabaan, M.; Elrakshy, Y.; Eltamawey, K.; Abd-El Aziz, M. Gamal; Saad, A.; Aboleineen, W.; Ashour, Z.; Sorour, K.; Mahdy, M. A.Meguid; Iserin, L.; Ladouceur, M.; Cohen, S.; Iung, B.; Maisuradze, D.; Mebus, S.; Gembruch, U.; Hammerstingl, C.; Merz, W. M.; 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, A. Vazan; Shotan, A.; Goland, S.; Festa, P.; Ali, L. Ait; Sinagra, G.; Puggia, I.; Mottolese, B. D.Agata; Carmina, M. G.; 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, J. M.J.; van Dijk, A.; Bellersen, L.; Duijnhouwer, T.; De Groot, C.; Pieper, E. P.G.; 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, I. Mircea; Gaisin, I. Ravilevich; Shilina, L. Valeryevna; Sharashkina, N.; Tkacheva, O.; Ivanov, D.; Irtyuga, O.; Jovovic, L.; Prokselj, K.; Kozelj, M.; Elliott, C.; Galian-Gay, L.; Pijuan-Domenech, A.; Subirana-Domenech, M. T.; Tornos, P.; Murga, N.; Oliver, J. M.; Escribano-Subías, P.; Ruiz-Cano, M. J.; Delgado-Jiménez, J.; Furenas, E.; Dellborg, M.; Thilén, U.; Schwerzmann, M.; Bouchardy, J.; Rutz, T.; Tobler, D.; Sarac, L.; Esen, O. Batukan; Enar, S. Catirli; 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, M. G.; Chintala, K.; Gupta, P.; Pare, E.; Khatri, N.; Scott, N.; De Faria-Yeh, D.; Bhatt, A. B.; Tsiaras, S.; Gurvitz, M.; Otto, C.; Botti, J.; Ting, J.; Davidson, W. R.
In: Heart, Vol. 104, No. 9, 01.05.2018, p. 745-752.Research output: Contribution to journal › Article › peer-review
}
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 - Sliwa, Karen
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 - 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.
AU - El Sayed Makled, W. A.
AU - Dardier, A.
AU - Shabaan, M.
AU - Elrakshy, Y.
AU - Eltamawey, K.
AU - Abd-El Aziz, M. Gamal
AU - Saad, A.
AU - Aboleineen, W.
AU - Ashour, Z.
AU - Sorour, K.
AU - Mahdy, M. A.Meguid
AU - Iserin, L.
AU - Ladouceur, M.
AU - Cohen, S.
AU - Iung, B.
AU - Maisuradze, D.
AU - Mebus, S.
AU - Gembruch, U.
AU - Hammerstingl, C.
AU - Merz, W. M.
AU - Wald, C.
AU - Baumgartner, H.
AU - Orwat, S.
AU - Schmidt, R.
AU - Motz, R.
AU - Olsson, A.
AU - Berger, F.
AU - Nagdyman, N.
AU - Frogoudaki, A.
AU - Anastasiou-Nana, M.
AU - Temesvari, A.
AU - Kohalmi, D.
AU - Balint, H.
AU - Merkely, B.
AU - Liptai, C.
AU - Bowen, M.
AU - Cullen, M.
AU - Thornton, P.
AU - Husarova, V.
AU - Blatt, A.
AU - Elbaz-Greener, G.
AU - Moravsky, G.
AU - Vered, Z.
AU - Fuhrmann, A. Vazan
AU - Shotan, A.
AU - Goland, S.
AU - Festa, P.
AU - Ali, L. Ait
AU - Sinagra, G.
AU - Puggia, I.
AU - Mottolese, B. D.Agata
AU - Carmina, M. G.
AU - Romeo, C.
AU - Crepaz, R.
AU - Fesslova, V.
AU - Azzarelli, A.
AU - Baldi, D.
AU - Bovenzi, F.
AU - Donvito, V.
AU - Vasario, E.
AU - Todros, T.
AU - Niwa, K.
AU - Mussagaliyeva, A.
AU - Mekebekova, D.
AU - Sharipova, S.
AU - Zaliunas, R.
AU - Jonkaitiene, R.
AU - Petrauskaite, J.
AU - Gumbiene, L.
AU - Jovanova, S.
AU - Cassar, A.
AU - Caruana, M.
AU - Karamermer, Y.
AU - Cornette, J. M.J.
AU - van Dijk, A.
AU - Bellersen, L.
AU - Duijnhouwer, T.
AU - De Groot, C.
AU - Pieper, E. P.G.
AU - van Oppen, C.
AU - Polak, P.
AU - Wajon, E.
AU - Wagenaar, L.
AU - Estensen, M.
AU - Lesniak-Sobelga, A.
AU - Podolec, P.
AU - Wisniowska-Smialek, S.
AU - Trybuch, A.
AU - Hoffman, P.
AU - Cichocka-Radwan, A.
AU - Sobczak, S.
AU - Faflik, U.
AU - Tomaszuk-Kazberuk, A.
AU - Przepiesc, J.
AU - Gil, M.
AU - Plaskota, K.
AU - Trojnarska, O.
AU - Guerra, N.
AU - de Sousa, L.
AU - Petrescu, V.
AU - Ginghina, C.
AU - Jurcut, R.
AU - Coman, I. Mircea
AU - Gaisin, I. Ravilevich
AU - Shilina, L. Valeryevna
AU - Sharashkina, N.
AU - Tkacheva, O.
AU - Ivanov, D.
AU - Irtyuga, O.
AU - Jovovic, L.
AU - Prokselj, K.
AU - Kozelj, M.
AU - Elliott, C.
AU - Galian-Gay, L.
AU - Pijuan-Domenech, A.
AU - Subirana-Domenech, M. T.
AU - Tornos, P.
AU - Murga, N.
AU - Oliver, J. M.
AU - Escribano-Subías, P.
AU - Ruiz-Cano, M. J.
AU - Delgado-Jiménez, J.
AU - Furenas, E.
AU - Dellborg, M.
AU - Thilén, U.
AU - Schwerzmann, M.
AU - Bouchardy, J.
AU - Rutz, T.
AU - Tobler, D.
AU - Sarac, L.
AU - Esen, O. Batukan
AU - Enar, S. Catirli
AU - Al Mulla, A.
AU - Bazargani, N.
AU - Al Hatou, E.
AU - Farook, F.
AU - Almahmeed, W.
AU - Salih, B.
AU - Clifford, P.
AU - Bowers, N.
AU - Veldtman, G.
AU - Kerr, J.
AU - Tellett, L.
AU - Hudsmith, L.
AU - Thompson, P.
AU - Thorne, S.
AU - Bowater, S.
AU - Nihoyannopoulos, P.
AU - Curry, R.
AU - Freeman, L.
AU - Schroeder, F.
AU - Wendler, R.
AU - Hammond, S.
AU - Talluto, C.
AU - Murphy, D.
AU - Perlroth, M. G.
AU - Chintala, K.
AU - Gupta, P.
AU - Pare, E.
AU - Khatri, N.
AU - Scott, N.
AU - De Faria-Yeh, D.
AU - Bhatt, A. B.
AU - Tsiaras, S.
AU - Gurvitz, M.
AU - Otto, C.
AU - Botti, J.
AU - Ting, J.
AU - Davidson, W. R.
N1 - Publisher Copyright: © 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
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 -