In-hospital management and outcomes in patients with peripartum cardiomyopathy: a descriptive study using a national inpatient database in Japan

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening cardiac disorder characterized by maternal systolic heart failure. Although PPCM is a major cause of maternal mortality, little is known about the acute-phase management of PPCM in real-world clinical settings. We retrospectively identified patients hospitalized with PPCM from 2007 to 2014 using the Diagnosis Procedure Combination database in Japan. We investigated patient characteristics, in-hospital examinations and treatment, and in-hospital outcomes. The study patients were 283 patients hospitalized with PPCM at 177 hospitals. The mean age was 32.7 +/- 5.5 years. Of the eligible patients, 134 (47.3%) patients had a hypertensive disorder, including 48 (17.0%) patients with pre-eclampsia, and 111 (39.2%) patients were admitted to the intensive care unit or emergency center. Coronary angiography, cardiac magnetic resonance imaging, and endomyocardial biopsy were performed during hospitalization in 69 (24.4%), 42 (14.8%), and 43 (15.2%) patients, respectively. Invasive pulmonary artery pressure monitoring was used in 14 (4.9%) patients. Mechanical circulatory support was used in 13 (4.6%) patients (intra-aortic balloon pumping, n = 12; extracorporeal membrane oxygenation, n = 5; ventricular assist device, n = 0). Catecholamine therapy and phosphodiesterase-III inhibitor therapy were used in 79 (27.9%) and 13 (4.6%) patients, respectively. Prolactin blockade therapy was used in 78 (27.6%) patients. During hospitalization, four (1.4%) patients died and nine (3.2%) patients developed ventricular tachycardia or fibrillation. Two (0.7%) patients received an implantable cardioverter defibrillator, but no patient received other permanent cardiac devices. This retrospective cohort study suggests that attending physicians should be ready to provide intensive care for patients with PPCM during the acute phase.