Abstract | March 24, 2024

Post-Partum Cardiomyopathy: Quality Improvement of Recognition and Referrals

Christine Sykalo, DO, Cardiovascular Disease Fellowship, PGY-4, NGMC, Gainesville, GA

Heidi Ehrenreich, PhD, MPH, Maternal Cardiac Program, NGMC Georgia Heart Institute, Gainesville, GA; Nitya Chandra, MD, Heart Failure and Transplant Medicine, Georgia Heart Institute, Gainesville, GA

Learning Objectives

  1. Identify risk factors associated with post-partum cardiomyopathy (PPCM)
  2. Recognize necessary lab work for PPCM screening
  3. Learn which pregnant patients should receive early referrals to cardiology

Background: Postpartum cardiomyopathy (PPCM) can be a life-threatening condition associated with reduced left ventricular ejection fraction below 45% and occurs during or within 5 months after pregnancy. Very little research is available on risk factors and no guidelines available on treatment.

Methods: Gap analysis was performed to identify risk factors. Within our health system from 07/02/2019 – 12/19/2022 we identified 29 patients with diagnosis of postpartum cardiomyopathy.

Results: Within our health system risk factors for post-partum cardiomyopathy were found to be: Essential hypertension, gestational hypertension, diabetes mellitus type 1 and 2, along with preeclampsia. Other research has suggested additional risk factors which were not seen within our health system including: Gestational diabetes mellitus, multiparity, and multiple gestations.

Conclusion: Our hospital system is building a high-risk cardiac OB clinic for patients who have a diagnosis or risk factors for postpartum cardiomyopathy. Algorithm is being created for earlier referrals and screening women with brain natriuretic peptide (BNP) labs for monitoring, even if they do not have symptoms. Current goal is to raise awareness and vigilance about PPCM diagnosis and improve quality of care for these women. While there are no guidelines, we recommend pregnant women be screened with BNP levels, to identify those at potential risk for PPCM.

References and Resources

  1. Sliwa K, Hilfiker-Kleiner D, Petrie MC, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. European Journal of Heart Failure. 2010;12(8):767-778. doi:10.1093/eurjhf/hfq120.
  2. Mehta LS, Warnes CA, Bradley E, et al. Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American heart association. Circulation. 2020;141(23):e884-e903. doi:10.1161/CIR.0000000000000772.
  3. Brown L. ClinicalKey. J Med Libr Assoc. 2013;101(4):342-343. doi:10.3163/1536-5050.101.4.023Lee S, Cho GJ, Park GU, et al. Incidence, risk factors, and clinical characteristics of peripartum cardiomyopathy in South Korea. Circ Heart Fail. 2018;11(4):e004134. doi:10.1161/CIRCHEARTFAILURE.117.004134 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297639/
  4. Haghikia A, Podewski E, Libhaber E, et al. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol. 2013;108(4):366. doi:10.1007/s00395-013-0366.
  5. Rana KF, Saeed A, Shamim SA, Tariq MA, Malik BH. The association between hypertensive disorders of pregnancy and peripartum cardiomyopathy. Cureus. 2019;11(10):e5867. doi:10.7759/cureus.5867.
  6. Bello N, Rendon ISH, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013;62(18):1715-1723. doi:10.1016/j.jacc.2013.08.717.
  7. Honigberg MC, Givertz MM. Peripartum cardiomyopathy. BMJ. 2019;364:k5287. doi:10.1136/bmj.k5287.
  8. Gentry MB, Dias JK, Luis A, Patel R, Thornton J, Reed GL. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol. 2010;55(7):654-659. doi:10.1016/j.jacc.2009.09.043.
  9. Krishnamoorthy P, Garg J, Palaniswamy C, et al. Epidemiology and outcomes of peripartum cardiomyopathy in the United States: Findings from the Nationwide Inpatient Sample. J Cardiovasc Med (Hagerstown). 2016;17(10):756-761. doi:10.2459/jcm.0000000000000222.
  10. Felker GM, Jaeger CJ, Klodas E, Thiemann DR, Hare JM, Hruban RH, Kasper EK, Baughman KL. Myocarditis and long-term survival in peripartum cardiomyopathy. Am Heart J. 2000 Nov;140(5):785-91. doi: 10.1067/mhj.2000.110091. PMID: 11054626. 
Back to Abstracts