Eclampsia and early readmission for cardiovascular disease

Abstract

Background and aims: Pre-eclampsia confers increased risks of long-term cardiovascular disease (CVD). However, little is known about CVD risk among patients diagnosed with eclampsia, especially in the post-partum period. The aim of this study was to determine whether patients with eclampsia are at increased risk for readmission for CVD within the first year after delivery.

Methods: Using the Nationwide Readmissions Database from 2010 to 2018, readmissions for CVD events were identified during the calendar year after delivery in patients with eclampsia. Prevalence rates of CVD readmission (per 100 000 deliveries) were determined, and associations between eclampsia and CVD rehospitalization were based on a confounder adjusted hazard ratio (HR) with a 95% confidence interval (CI). A quantitative bias analysis addressed eclampsia misclassification and unmeasured confounding biases.

Results: Of over 27 million delivery hospitalizations, 20 478 (74.7 per 100 000) were complicated by eclampsia. CVD readmission rates among the eclampsia and normotensive patients were 854 and 147 per 100 000 delivery hospitalizations, respectively (rate difference 707, 95% CI 473-941; HR 6.9, 95% CI 4.5-10.4). HRs were high for specific heart disease types (range of adjusted HRs 4.8 to 15.5). Eclampsia was associated with a substantially high risk for stroke readmissions (adjusted HR 12.6, 95% CI 6.9-22.8).

Conclusions: Eclampsia is associated with an increased risk for CVD complications compared with normotensive conditions, even as early as the first month following delivery. These data highlight the need for targeted short-term follow-up for CVD complications among patients whose pregnancies are complicated by eclampsia.

Keywords: Cardiovascular disease; Eclampsia; Heart disease; Post-partum period; Pregnancy; Stroke.