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Tag: mortality

Cardiovascular Morbidity and Mortality in Pregnancy

More than one fifth of all pregnancy-associated deaths during a 10-year period in Illinois were the result of cardiovascular causes, and the mortality rate resulting from cardiac causes rose with maternal age, new data study show.

Further, of the cardiac-associated deaths, 28.1% of them were potentially preventable, Joan Briller, MD, from the Division of Cardiology, Department of Medicine, and the Center for Research on Women and Gender at the University of Illinois at Chicago, and colleagues report in an article published online April 4 in Obstetrics & Gynecology.

Recent research has shown that the maternal mortality rate in the United States has risen substantially in recent years, with one study of national trends reported by Medscape Medical News indicating a relative increase of more than 25% between 2000 and 2014.

Because cardiovascular disease is recognized as a leading contributor to US maternal mortality, Dr Briller and colleagues sought to identify the most common etiologies of maternal cardiac death in Illinois and to assess their potential preventability.

The investigators reviewed data on pregnancy-associated cardiovascular deaths in the state from 2002 to 2011. Data were collected by a network of regional perinatal centers and recorded in the Illinois Department of Public Health maternal mortality review database. Illinois requires the reporting and review of all deaths to women within a year of pregnancy.

During the period of study, there were 636 deaths in women who were pregnant or within 1 year of pregnancy, reflecting an overall death rate of 37.1 per 100,000 live births. Of the deaths, 140 (22.0%) were cardiac-related, predominantly (97.1%) resulting from acquired heart disease. The most common etiology was cardiomyopathy (27.9%), followed by stroke (22.9%), hypertension-related death (12.9%), arrhythmias (10.7%), and coronary artery disease (9.3%). Of the 39 women who died of cardiomyopathy, 30.8% (n = 12) developed the condition during the peripartum period.

Of the cardiovascular deaths, those attributed to cardiomyopathy “were significantly more likely to be considered directly related to pregnancy (P<.01) than other cardiac etiologies,” the authors write, and women with cardiomyopathy “were more likely to be younger than women who died of other cardiovascular causes,” they observe. The cardiomyopathy mortality rate in women younger than 20 years was nearly three times that of women aged 20 to 29 years (rate ratio [RR], 3.38; 95% confidence interval [CI], 1.38 – 8.27).

More than half of the cardiovascular deaths in this patient population occurred during the first 6 weeks postpartum compared with deaths from noncardiac causes (56.7% vs 49.2%; P < .01). This suggests that women with hypertension, preeclampsia, or other cardiac risk factors or symptoms should receive more extensive postpartum care, the authors write.

“[T]he preponderance of cardiovascular deaths in the older population is especially striking given that only 40.1% of births occurred in women older than age 30 years of age,” the authors write. “Increasing cardiovascular death as women aged is partly explained by the rising prevalence of cardiovascular disease in the older population,” they explain.

Of the cardiac deaths, 28.1% were determined to be potentially preventable and point to aspects of care that are “amenable to change such as monitoring patients at risk for several weeks postpartum,” the authors write.

The Illinois findings “add to our understanding of cardiovascular disease as a leading contributor to maternal mortality by addressing risk factors to be assessed and that a large proportion of maternal mortality is potentially preventable by addressing issues such as the importance of monitoring patients at risk for several weeks postpartum while hemodynamic changes are still in flux,” the authors conclude. “Our data support the need for more investigations into cardiovascular maternal mortality, organized communication between obstetricians and cardiologists, and the need for systems designed to better educate and communicate cardiovascular risk factors and warning signs to pregnant women and medical care providers.”

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Cardiovascular Mortality Rates Vary by Geography

It’s a testament to modern medicine that death rates from heart disease around the nation have been cut in half, yet new research sheds light on the wide disparities in cardiovascular death rates depending on geography. Using death certificate data, a research group led by University of Washington Medical Center cardiologist Dr. Gregory Roth conducted the most comprehensive analysis of deaths due to cardiovascular diseases in history.

Their findings indicated that cardiovascular death rates have been cut in half since 1980, though cardiovascular disease still represents the cause of death in the United States. In 2014, for instance, cardiovascular diseases accounted for more than 846,000 deaths, according to the research, which was published in the Journal of the American Medical Association.

But death rates can vary widely: for example, cardiovascular death rates are twice as high in Richmond, Martin and Columbus counties as they are in Chatham County. “This kind of variation occurs on a really small geographic level. So even from one county to the next we see these huge gaps in health related to heart disease,” said Roth. “We clear see higher rates of cardiovascular deaths in places that are poor, and we know that health care quality is worse in locations with lower incomes and lower levels of education.”

Moreover, there are early warning signs. Across the state and nation, cardiovascular death rates have begun to creep up again. “Cardiovascular disease is down on average in the United States, but the rate that it’s been going down has really flattened and in the last year or two we’ve seen very little decline at all. And in some states and counties we are actually seeing it go up again for the first time in 50 years,” said Roth.

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Live Longer By Saying “I Do”

In a new study published last week in the Journal of the American Heart Association, researchers at Emory University in Atlanta found that people with cardiovascular disease who were not married –- including those who were divorced, separated, widowed or never married –- had 24 percent higher rates of death from any cause during the study period, compared to those who were married. 

Specifically, not being married was associated with a higher risk of death from cardiovascular causes, like heart attacks and strokes, for the more than 6,000 Emory Healthcare patients in this study. Divorced and separated people had a 41 percent increased risk of death; widowed people had nearly double that risk.

“I was somewhat surprised at the impact,” Dr. Arshed Quyyumi, the study’s lead researcher and co-director of Emory Clinical Cardiovascular Research Institute, told ABC News. “But we suspected there might be something, since there have been studies that signal that marital status affects how well people do.”

This was a large study conducted between 2003 and 2015 that included 50 to 70 year old participants, from diverse racial groups, who had cardiovascular disease — including coronary artery disease, heart failure and previous heart attacks. Each participant was followed for an average of 3.7 years.

Even after accounting for known cardiac risk factors — such as diabetes and smoking, different types of heart disease, socioeconomic background, age, sex and appropriate treatment –- being unmarried still showed higher risk of death for these patients.
One expert not involved with the research agreed that the findings offer additional clues to the importance of relationships when it comes to health.

“This study adds to this line of research,” Dr. Matthew Dupre, an associate professor at Duke University who has done extensive research on social factors and heart outcomes, told ABC News. “There is now a growing body of work showing how our social relationships, particularly the disruption of these relationships through divorce or widowhood, can get under our skin and have immediate and lasting consequences for our cardiovascular health.”

For this study, the researchers did not specifically look for why these differences exist. But the research team, as well as Dupre, note that previous research suggests less social support, stress from divorce or a spouse passing and less motivation to have a healthy lifestyle, or to stick to medical treatment, may play a role.

“All these things can be put under the basket of social support,” study author Quyyumi said. “Cardiovascular disease, even though we consider diabetes and high cholesterol to be high risk factors, it is sizably impacted by psychosocial status –- how stressed you are, how depressed you are. Being alone, lonely, etc. may well do the same.”

For people who are widowed or getting divorced, there may be other stressors that can lead to worse heart health. “After the depression and grieving, be alerted to the fact that your life is altered and don’t fall into high risk behaviors. Perhaps, create a social network,” Quyyumi said. “All those things become important.”

The researchers did not account for people who changed their marriage status during the study, but Quyyumi explained that would not likely affect the results because only a small amount of people in their sixties change marital status over the course of two to seven years. The study also did not specifically account for people who have partners, but are not married.

“I wouldn’t say that if you have heart disease, you have to get married. I’m not sure anyone has prescribed getting married to prevent getting sicker,” Quyyumi said. “But I think doctors and even family and friends can pay more attention when life events occur –- perhaps these people need extra care and attention to compensate for things they are now missing.”

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