Risk Factors and Temporal Trends of Maternal Heart Failure

Background

Maternal heart failure (HF) is increasing in several countries, but trends in Sweden remain unclear. The extent to which changes in maternal risk factors contribute to this trend and the proportion of cases linked to associated cardiac conditions are not well established.

Objectives

The purpose of this study was to estimate the annual incidence of maternal HF in Sweden over the last 2 decades, assess the proportion with associated cardiac disease, identify risk factors, and examine whether changes in risk factor prevalence explain temporal trends.

Methods

National cohort study comprising 2,078,384 deliveries to women without pre-existing cardiac disease registered in the Swedish Medical Birth Register (2000-2019). Cases of maternal HF, with and without associated cardiac disease, were identified through linkage with national patient and mortality register. Annual incidence rates were calculated, stratified by pregnancy- or postpartum-onset and cardiac disease status. Multivariable logistic regression was used to assess risk factors.

Results

Maternal HF increased by 66% over the study period, with an overall incidence of 0.34 cases per 1,000 deliveries (95% CI: 0.30-0.38). Associated cardiac disease was present in approximately one-half of cases. Identified risk factors included prepregnancy comorbidities and pregnancy complications. The rising incidence was partly, yet not fully, explained by changes in risk factor prevalence.

Conclusions

The increasing incidence of maternal HF in Sweden highlights a growing clinical concern. The high prevalence of associated cardiac disease underscores the need for heightened awareness and appropriate management of affected patients.