title: Epidemiology and outcomes of peripartum cardiomyopathy in the United States: findings from the Nationwide Inpatient Sample.
abstract: OBJECTIVE
  Peripartum cardiomyopathy (PPCM) is defined as systolic heart failure within the last month of pregnancy or 5 months after delivery in the absence of any identifiable cause of heart failure. We aimed to investigate the prevalence of PPCM and predictors of in-hospital mortality in patients with PPCM.
  
  
  METHODS
  We analyzed patients with diagnosis of PPCM from the Nationwide Inpatient Sample database using the Ninth Revision of International Classification of Diseases (ICD-9) from 2009 to 2010. We categorized PPCM (n = 4871) into three groups of presentation based on their ICD-9 codes: antepartum (674.53; n = 189), peripartum (674.51, 674.52; n = 887) and postpartum (674.54; n = 3741).
  
  
  RESULTS
  PPCM was more common in African-Americans (43.9%) as compared with white (40.8%), Hispanic (8.7%) and Asian (2.7%) women. Hypertensive disorders were classified as pre-existing hypertension (31.6%), gestational hypertension (3.7%), preeclampsia (9.9%), eclampsia (2.4%) and preeclampsia/eclampsia superimposed on hypertension (3.1%). Among different ethnicities, pre-existing hypertension (1 : 2.3) and diabetes (1 : 10.4) were more prevalent in African-Americans, whereas preeclampsia (1 : 4.3) and premature labor (1 : 5.4) were more common in Asians. In-hospital mortality rate was 1.8%, with 2.1% in the postpartum and 0.5% in the peripartum group. Asians had the highest mortality (8.3%). In multimodel regression analysis, Asians [odds ratio (OR) 9.68, 95% confidence interval (CI) 1.11-83.9, P = 0.03] and length of stay (OR 1.06, 95% CI 1.03-1.10, P < 0.01) were associated with increased mortality, whereas white women were associated with reduced mortality (OR 0.10, 95% CI 0.02-0.59, P = 0.01).
  
  
  CONCLUSIONS
  Although PPCM was prevalent in African-Americans, Asians had higher in-hospital mortality, increased prevalence of preeclampsia and premature labor. Also, mortality rate was significantly higher in the postpartum group.
authors.affiliation: aDepartment of Medicine, Englewood Hospital and Medical Center, New Jersey bDepartment of Internal Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, New York cDepartment of Medicine, Division of Cardiology, University of Texas, Texas, USA.
authors.forename: Parasuram
authors.initials: P
authors.lastname: Krishnamoorthy
authors.forename: Jalaj
authors.initials: J
authors.lastname: Garg
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.forename: Hasan
authors.initials: H
authors.lastname: Ahmad
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.forename: Gregg
authors.initials: G
authors.lastname: Lanier
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000208:ethnology*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000208:ethnology*; D006801:Humans; D058725:Peripartum Period; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000208:ethnology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000145:classification* / Q000208:ethnology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology