heart failure in late pregnancy and postpartum incidence and long term mortality in sweden 1997 2010

Accepted Manuscript Title: Heart Failure in Late Pregnancy and Postpartum: Incidence and LongTerm Mortality in Sweden 1997–2010 Author: Anders Barasa, Annika Rosengren, Tatiana Zverkova Sandström, Lars Ladfors, Maria Schaufelberger PII: DOI: Reference: S1071-9164(17)30002-7 http://dx.doi.org/doi: 10.1016/j.cardfail.2016.12.011 YJCAF 3912 To appear in: Journal of Cardiac Failure Received date: Revised date: Accepted date: 7-3-2016 15-12-2016 29-12-2016 Please cite this article as: Anders Barasa, Annika Rosengren, Tatiana Zverkova Sandström, Lars Ladfors, Maria Schaufelberger, Heart Failure in Late Pregnancy and Postpartum: Incidence and Long-Term Mortality in Sweden 1997–2010, Journal of Cardiac Failure (2017), http://dx.doi.org/doi: 10.1016/j.cardfail.2016.12.011 This is a PDF file of an unedited manuscript that has been accepted for publication As a service to our customers we are providing this early version of the manuscript The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain Heart failure in late pregnancy and postpartum: incidence and long-term mortality in Sweden 1997–2010 Anders Barasa*1, MD; Annika Rosengren1, MD, PhD; Tatiana Zverkova Sandström1, Bsc; Lars Ladfors2, MD, PhD; Maria Schaufelberger1, MD, PhD Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital/Östra, University of Gothenburg, Sweden Word count manuscript excl references, legends, figures and tables): 311 Word count abstract (excluding key words): 236 *Corresponding author, Department of Medicine, Sahlgrenska University Hospital/Ưstra, SE-416 85 Gưteborg, Sweden Telephone: +254707121484, fax: +4631258933 E-mail: anders.barasa@gu.se Highlights  Heart failure in late pregnancy and postpartum is rare in Sweden  From 1997 – 2010 heart failure in the peri- and postpartum occurred in in every 5719 deliveries  HF in pregnancy and postpartum was linked to preeclampsia, obesity and twin deliveries  Mothers born in low and middle-income countries were more likely to be afflicted  Deliveries associated with HFPP were 35 times more likely to have a fatal outcome Abstract Aims Heart failure (HF) in late pregnancy and postpartum (HFPP) of which peripartum cardiomyopathy (PPCM) comprises the larger part, is still a rare occurrence in Sweden Population-based data are scarce Our aim was to characterise HFPP and determine the incidence and mortality in a Swedish cohort Page of 24 Methods and results Through merging data from the National Inpatient, Cause of Death, and Medical Birth Registers, we identified ICD-10 codes for HF and cardiomyopathy, within months before delivery up to months postpartum Each case was assigned age-matched controls from the Medical Birth Register From 1997-2010, 241 unique HFPP-cases and 1063 matched controls were identified Mean incidence was in 719 deliveries HFPP was strongly associated with preeclampsia, odds ratio (OR 11.91, 95% CI 7.86– 18.06), obesity OR 2.5, 95% CI 1.7–3.7), low and middle-income country (LMIC) origin, OR 1.73, (95% CI 1.14–2.63) and twin deliveries, OR 4.39 (CI 95% 2.24-8.58) By the end of the study period deaths among cases were >35-fold those of controls, cases (3.7 %) and control (0.1 %), P