Abstract Body (Do not enter title and authors here): Background: Cardiovascular disorders stand as primary contributors to the mounting maternal morbidity and mortality rates. Heart failure with reduced ejection fraction (HFrEF), whether stemming from ischemic, valvular disease, or peripartum cardiomyopathy etiologies, stands as a prominent source of morbidity.
Methods: This retrospective cohort study analyzed the NIS database from 2016-2020. Delivery hospitalizations were identified using ICD-10 codes and then categorized based on acute HFrEF ( AHFrEF) exacerbation diagnoses. Mortality, cardiovascular and obstetric outcomes were analyzed using multivariate logistic regression.
Results: There was a total of 3,945,233 delivery-related hospitalizations, of which 420 ( 0.01%) had a scondary diagnosis of AHFrEF. AHFrEF patients were older (mean age 31 vs 28 year-old, p-value<0.001), and encompassed more African Americans (26 vs 18 %, p=0.010) and Hispanics (26% vs 18%, p=0.010); they also had a higher comorbidity burden as assessed by the elixhauser index (p<0.001).
Univariate analysis showed a remarkable increase in in-patient mortality [Odds Ratio: 186; 95% confidence Interval ( CI ): 25-1369, p<0.001], but there was no statiscally significant difference after adjustments for confounders. [adjusted OR: 8.3 ; 95% CI: 0.76-89, p=0.081]. Patients with AHFrEF had 3.64 days longer length of stay ( 95% CI : 2.28-5.01; p-value<0.001), and a 73,984 USD higher total
charges [95 % CI: 51,130-96,837, p-value<0.001] compared to non-AHFrEF patients. They also had higher odds of having pre-eclampsia [aOR:2.34, 95% CI: 1.44-3.82, p-value<0.001], peri-partum bleeding, [aOR:2.67; 95 % CI: 51,130-96,837, p-value<0.001],and required more blood transfusion (aOR: 2.5; 95% CI: 1.26-5.09, p-value 0.011), and Cesarian section [aOR: 3.5, 95 % CI: 2.5-5, pvalue=0.045]. The AHFrEF cohort had a higher risk of arrythmia [aOR: 5; 95% CI: 4.8-16, p-value=0.023], acute kidney injury [aOR: 5.65; 95% CI: 2.86-11.16, p-value<0.01] and pericardial effusion [aOR: 2.34; 95 %CI: 1.44-3.82, p-value=0.001].
Conclusion: AHFrEF patients had significantly greater risk for adverse obstetric outcomes, which substantially increased hospital and economic burden.