PPCM in Scotland v1

  • Research type

    Research Study

  • Full title

    The epidemiology of peripartum cardiomyopathy in a Western European country: An analysis of the Scottish population from 1986-2017

  • IRAS ID

    254827

  • Contact name

    Pardeep Jhund

  • Contact email

    Pardeep.Jhund@glasgow.ac.uk

  • Sponsor organisation

    NHS Greater Glasgow and Clyde

  • Duration of Study in the UK

    3 years, 0 months, 1 days

  • Research summary

    Summary of Research
    Peripartum cardiomyopathy (PPCM) is a pregnancy-related heart condition in which the heart's ability to pump blood is reduced (heart failure). PPCM affects women towards the end of pregnancy or in the first few months after delivery. The number of women affected by PPCM in the UK is unknown. While some women make a full recovery, in others heart function worsens and may lead to the need for a heart transplant, or even death. Women who develop PPCM are also at risk of other life-threatening complications, such as development of blood clots, heart attacks or strokes. The cause of PPCM is poorly understood and no specific treatments are available. A big problem for doctors and patients is the lack of information to help guide decisions. Studies that have looked at PPCM are generally small and only from certain parts of the world. To improve the care of women with PPCM, we must first understand the condition better.

    Our study proposes to address major gaps in our knowledge by looking back at medical information from women who have had PPCM between 1986 and 2017. We will describe how frequent PPCM is, what factors increase the likelihood of developing it, what outcomes are for women and their babies, and what factors are linked to worse outcomes for the mother and baby. We will also approximate how many 'possible' cases of PPCM exist - these are women who are given a more general diagnosis of 'heart failure' but who are more likely to have PPCM.

    Women with the condition will first be identified using routinely collected NHS data in Scotland. Because not all of the information required is available this way, we will also collect information directly from patient records.

    Lay summary of study results: PPCM in Scotland occurred in around 1 in 4950 deliveries over a 20 year period. The incidence was greater in women over the age of 32 years.

    Among 225 women with PPCM (and 2240 matched controls), gestational hypertensive disorders (high blood pressure during pregnancy), multiparity and multiple gestation were independent risk factors for the development of PPCM in this Scottish cohort. Socioeconomic deprivation was also relevant, although this appeared to be explained by other baseline factors studied.

    Over a median follow-up of 8.4 years (9.6 years for echocardiographic outcomes), 8% of women with PPCM died, 40% were rehospitalised at least once for a CV cause and 23% had at least two further CV hospitalisations (i.e. a recurrent hospitalisation). Complete left ventricular recovery occurred in 76% of women throughout the whole study period (47% within 1 year), and, of those who recovered, 13% had sustained decline of LV systolic function despite initial recovery, at a median of 2.85 years after recovery.

    Women with PPCM with a subsequent pregnancy were younger and more deprived than those without. Clinical outcomes examined were similar in women with PPCM irrespective of whether or not they went on to have a subsequent pregnancy. Furthermore, no adverse CV events (CV death, mechanical circulatory support or cardiac transplant) occurred in women with PPCM during a subsequent pregnancy or in the 12 months postpartum.

    Approximately 1 in 3 children born to women with PPCM had an adverse neonatal outcome, with 4% case-fatality (including stillbirths) and a mortality rate approximately 5-times that of children born to matched controls. Children born to women with PPCM also had an approximately 3-times greater rate of cardiovascular disease than children born to matched controls.

    Summary of Results
    PPCM in Scotland occurred in around 1 in 4950 deliveries over a 20 year period. The incidence was greater in women over the age of 32 years.

    Among 225 women with PPCM (and 2240 matched controls), gestational hypertensive disorders (high blood pressure during pregnancy), multiparity and multiple gestation were independent risk factors for the development of PPCM in this Scottish cohort. Socioeconomic deprivation was also relevant, although this appeared to be explained by other baseline factors studied.

    Over a median follow-up of 8.4 years (9.6 years for echocardiographic outcomes), 8% of women with PPCM died, 40% were rehospitalised at least once for a CV cause and 23% had at least two further CV hospitalisations (i.e. a recurrent hospitalisation). Complete left ventricular recovery occurred in 76% of women throughout the whole study period (47% within 1 year), and, of those who recovered, 13% had sustained decline of LV systolic function despite initial recovery, at a median of 2.85 years after recovery.

    Women with PPCM with a subsequent pregnancy were younger and more deprived than those without. Clinical outcomes examined were similar in women with PPCM irrespective of whether or not they went on to have a subsequent pregnancy. Furthermore, no adverse CV events (CV death, mechanical circulatory support or cardiac transplant) occurred in women with PPCM during a subsequent pregnancy or in the 12 months postpartum.

    Approximately 1 in 3 children born to women with PPCM had an adverse neonatal outcome, with 4% case-fatality (including stillbirths) and a mortality rate approximately 5-times that of children born to matched controls. Children born to women with PPCM also had an approximately 3-times greater rate of cardiovascular disease than children born to matched controls.

  • REC name

    West of Scotland REC 4

  • REC reference

    19/WS/0041

  • Date of REC Opinion

    7 Mar 2019

  • REC opinion

    Favourable Opinion