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Relationship Between Race, Predelivery Cardiology Care, and Cardiovascular Outcomes in Preeclampsia/Eclampsia Among a
Ikeoluwapo Kendra Bolakale-Rufai1, Shannon M Knapp2,3, Brownsyne Tucker Edmonds4
1Department of Internal Medicine (I.K.B.-R.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
Black patients with preeclampsia/eclampsia (PrE/E) face higher major adverse cardiovascular events (MACE) risk post-delivery. Predelivery cardiology care reduced MACE risk for White patients within 14 days, but not for Black patients.
Area of Science:
- Cardiovascular Medicine
- Obstetrics
- Public Health
Background:
- Preeclampsia/eclampsia (PrE/E) poses risks for major adverse cardiovascular events (MACE).
- The impact of predelivery cardiology care on MACE risk in PrE/E patients, particularly by race, is not well understood.
- Investigating racial disparities in MACE incidence and the role of cardiology care is crucial for equitable maternal health outcomes.
Purpose of the Study:
- To determine the cumulative incidence of MACE up to one year post-delivery in Black and White patients with PrE/E.
- To assess whether predelivery cardiology care is associated with the hazard of MACE in these populations.
- To examine racial differences in the effectiveness of cardiology care for mitigating MACE risk.
Main Methods:
- Utilized Optum's Clinformatics Data Mart Database to identify Black and White patients with PrE/E (2008-2019).
- Defined MACE as a composite of heart failure, myocardial infarction, stroke, and death.
- Employed regression models to analyze the hazard of MACE by cardiology care status, with separate analyses for the first 14 days and the remainder of the year post-delivery.
Main Results:
- Black patients exhibited a higher 1-year MACE incidence (2.7%) compared to White patients (1.4%), with most events occurring within 14 days.
- Predelivery cardiology care was linked to a significantly lower hazard of MACE for White patients within 14 days (HR, 0.31; P<0.001).
- No significant association was found between cardiology care and MACE hazard for Black patients within 14 days (HR, 1.00; P=0.999), with a significant interaction effect between race and cardiology care in this period.
Conclusions:
- Black patients with PrE/E have a higher cumulative incidence of MACE post-delivery compared to White patients.
- Predelivery cardiology care demonstrated a protective effect against MACE for White patients in the early postpartum period (within 14 days).
- The findings highlight a racial disparity in the benefit of cardiology care for PrE/E patients, underscoring the need for tailored interventions.
Background:
It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E.
Methods:
Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year.
Results:
Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21-0.46]; P<0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60-1.67]; P=0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (P<0.001) but not the remainder of the year (P=0.56).
Conclusions:
Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.
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