By AMERICAN HEART ASSOCIATION NEWS
After her third child was born, Golda Black complained to her doctors about a persistent cough while lying down, along with fatigue, dizziness and chest pains.
As she looked for possible explanations online, heart failure kept appearing in her results.
“My husband thought I was being ridiculous because we didn’t think 29-year-olds could have heart failure,” she said.
By the time her son Cooper was 10 weeks old, testing revealed Black’s heart was working at 10 to 15 percent of its capacity, and she was diagnosed with peripartum cardiomyopathy and chronic heart failure.
Heart failure is a leading cause of maternal morbidity and death in the U.S. – with the rate of pregnancy-related deaths more than doubling between 1987 and 2011. But much about heart failure before, during and after delivery has been unknown.
Now, a study released Friday in Circulation: Heart Failure sheds light on when heart failure occurs during pregnancy and those at highest risk, leading researchers to call for increased vigilance by multidisciplinary medical teams and greater patient awareness, and targeted public health measures to improve outcomes and reduce disparities.
Although less than 2 percent of all pregnancy-related hospitalizations were due heart failure, most — nearly 60 percent — of those pregnancy-related heart failure hospitalizations occurred during the six-week period following delivery, the study found.
Dr. Mulubrhan F. Mogos, the study’s lead author, said the results represent “significant clinical implications,” highlighting the importance of early intervention. Focusing on the postpartum period is crucial, Mogos said, because typically women are discharged a few days after delivery and don’t undergo evaluation from a health care provider until six weeks later, meaning symptoms could go unrecognized and untreated.
“Either we’re not doing a good job of detecting potential risk factors when we discharge after labor and delivery, or we’re not doing a good job following or monitoring their condition during early postpartum period,” said Mogos, an assistant professor of nursing at the University of Illinois’s Department of Women, Children and Family Health Science.
The study analyzed more than 50 million pregnancy-related hospitalizations in the U.S. from 2001 to 2011. From 2001 to 2006, there was a 7.1 percent increase each year in heart failure diagnoses among postpartum hospitalizations, followed by a steady rate through 2011. However, heart failure rates during the antepartum period – or prior to delivery – increased by an average of 4.9 percent per year from 2001 to 2011, which researchers said may be attributable to high blood pressure, diabetes and other risk factors that women already had before becoming pregnant, and improved testing to detect heart failure.
Researchers also uncovered some noticeable differences in who developed heart failure. Across the pregnancy continuum, women with a heart failure diagnosis were more likely to be older, black, live in the South and in a lower household income area, and use tobacco, drugs or alcohol.
Dr. JoAnn Lindenfeld, who leads clinical research as director of the Advanced Heart Failure/Cardiac Transplantation programs at Vanderbilt University in Nashville and was not involved in the study, said the findings may guide better screening for high-risk patients before they leave the hospital.
“The sooner we recognize peripartum cardiomyopathy, the more likely we can prevent rehospitalization and improve outcomes,” she said.
Lindenfeld said the study also highlights the need for greater patient awareness about risks and how to recognize symptoms.
“If patients feel they’re having more symptoms than they should, they should talk to their doctor and ask, ‘Could it be heart failure?’”
Mogos agreed greater awareness about risk factors and symptoms for heart failure are needed, particularly among patients who may have other conditions during pregnancy, such as preeclampsia or gestational diabetes.
“When care transitions from the OB/GYN to the primary care physician, there isn’t always good communication, especially if symptoms have gone away,” he said.
Because the database did not include information on each woman’s treatment for heart failure, researchers were unable to analyze the effectiveness of various treatment approaches.
For Black, medication and lifestyle changes have helped her heart regain some of its capacity. A procedure to minimize leaking from her heart’s mitral valve has also helped.
“If you think something is wrong, you have to keep trying to get answers until you find someone who listens to you,” said Black, now 32. “I’m just trying to get every last beat out of this heart that I can before I need to trade it in for a new one.”
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