Factors Associated with Intra-hospital Mortality of Peripartum Cardiomyopathy Patients in Northcentral Nigeria

Abstract

Aims:  We studied the patient characteristics, intra-hospital outcomes and factors associated with intra-hospital mortality in patients admitted for Peripartum Cardiomyopathy (PPCM) in our centre using data from the Ilorin Heart failure Registry. Study design: Prospective Observational Methodology: All the 22 confirmed PPCM patients admitted between January 1, 2016 and December 31, 2019 were recruited and followed up for intra-hospital outcomes. The primary outcome was all-cause intra-hospital mortality. Results: Intra-hospital death occurred in four out of 22 patients (18.2%). The mean age of all patients was 28.4 ± 4.8 years and it was similar in both survivors and patients who died (P=0.960). Majority of patients (14, 63.7%) presented in New York Heart Association Class IV. Mean duration of hospital stay was 11 + 5.7days which was similar between patients who died and those who survived hospital admission (9.0 ± 2.8 vs 11.4 ± 6.1, P=0.457). Median ECG heart rate was 120 (116-123) bpm which was similar between both groups. Factors associated with mortality were biochem ical parameters serum sodium and eGFR which were significantly lower among those who died (125.0 ± 4.1 vs 133.7 ± 2.5mmol/L, P=<0.001; 41.0 ± 18.8 vs 81.9 ± 11.03 mls/min/1.73m2, P<0.001) and the Ejection fraction (EF) and Fractional Shortening (FS) which were also significantly lower in the patients who died 24.0 ± 8.2% vs 37.9 ± 6.2%, P=0.002; 11.0 ± 4.3% vs 18.4 ± 3.8, P=0.003 respectively. Other echocardiographic parameters were similar between the two groups of patients.  A Kaplan-Meier survival curve was drawn to show the time to outcome. Conclusion: Majority of PPCM patients present in clinically severe heart failure and the intra-hospital mortality is high. The importance of serum sodium, eGFR, EF and FS as factors associated with mortality indicates patient sub-groups requiring greater attention and targeted interventions.