A Global Perspective on the Management, Outcomes and Complications of Peripartum Cardiomyopathy: A Systematic Review and Meta-Analysis

Abstract

Background: Peripartum cardiomyopathy (PPCM) remains a major contributor to maternal morbidity and mortality worldwide. The disease is associated with various complications occurring mainly early during its course. Reported adverse outcomes include decompensated heart failure, thromboembolic complications, arrhythmias and death. We sought to systematically and comprehensively review published literature on the management, complications and outcome of women with PPCM across different geographical regions and to identify possible predictors of adverse outcomes.

Methods: We performed a comprehensive search of relevant literature (2000 to June 2021) across a number of electronic databases. Cohort, case-control and cross-sectional studies, as well as control arms of randomised controlled trials (RCTs) reporting on the in-hospital complications and six- and/or twelve-month outcomes of PPCM were considered eligible. The protocol was registered with PROSPERO (CRD42021255654).

Findings: Forty-seven studies (4875 participants across 19 countries) met the inclusion criteria. Haemodynamic and echocardiographic parameters were similar across all continents. All-cause mortality was 8.0% [95% CI 5.5-10.8, I2 =79.1%) at six months and 9.8% [95% CI 6.2-14.0], I2 =80.5%) at twelve months, respectively. All-cause mortality was highest in Africa and Asia/Pacific. Overall, 44.1% ([95% CI 36.1-52.2], I2 =91.7%) of patients recovered their LV function within six months and 58.7% ([95% CI 48.1-68.9], I2 =75.8%) within twelve months, respectively. Europe and North America reported the highest prevalence of LV recovery. Frequent prescription of beta-blocker, ACE-I/ARB and bromocriptine/cabergoline were associated with significantly lower all-cause mortality and better LV recovery.

Interpretation: We identified significant global differences in prevalence of in-hospital complications, six- and twelve-month outcomes, and treatment prescriptions. Frequent prescription of guideline-directed heart failure therapy was associated with better LV recovery and lower all-cause mortality. Timely initiation and up-titration of heart failure therapy should therefore be strongly encouraged to improve outcome.

Funding Information: None.

Declaration of Interests: We declare no competing interests.

Keywords: peripartum cardiomyopathy, systematic review, meta-analysis, complications, outcomes, mortality, heart failure, thromboembolism, LV recovery.