Preeclampsia Predicts Risk of Hospitalization for Heart Failure With Preserved Ejection Fraction

J Am Coll Cardiol. 2021 Dec 7;78(23):2281-2290. doi: 10.1016/j.jacc.2021.09.1360.


Background: Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established.

Objectives: The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia.

Methods: A retrospective cohort study using the New York and Florida state Healthcare Cost and Utilization Project State Inpatient Databases identified delivery hospitalizations between 2006 and 2014 for women with and without preeclampsia/eclampsia. The authors identified women admitted for HF after discharge from index delivery hospitalization until September 30, 2015, using International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes. Patients were followed from discharge to the first instance of primary outcome (HFpEF hospitalization), death, or end of study period. Secondary outcomes included hospitalization for any HF and HF with reduced ejection fraction, separately. The association between preeclampsia/eclampsia and HFpEF was analyzed using Cox proportional hazards models.

Results: There were 2,532,515 women included in the study: 2,404,486 without and 128,029 with preeclampsia/eclampsia. HFpEF hospitalization was significantly more likely among women with preeclampsia/eclampsia, after adjusting for baseline hypertension and other covariates (aHR: 2.09; 95% CI: 1.80-2.44). Median time to onset of HFpEF was 32.2 months (interquartile range: 0.3-65.0 months), and median age at HFpEF onset was 34.0 years (interquartile range: 29.0-39.0 years). Both traditional (hypertension, diabetes mellitus) and sociodemographic (Black race, rurality, low income) risk factors were also associated with HFpEF and secondary outcomes.

Conclusions: Preeclampsia/eclampsia is an independent risk factor for future hospitalizations for HFpEF.

Keywords: HFpEF; heart failure; preeclampsia; pregnancy; women.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Follow-Up Studies
  • Heart Failure / epidemiology
  • Heart Failure / etiology*
  • Heart Failure / physiopathology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Middle Aged
  • Pre-Eclampsia / epidemiology
  • Pre-Eclampsia / physiopathology*
  • Pre-Eclampsia / therapy
  • Pregnancy
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Stroke Volume / physiology*
  • United States / epidemiology
  • Ventricular Function, Left / physiology*
  • Young Adult