Relationship Between Race, Predelivery Cardiology Care and Cardiovascular Outcomes in Pre-Eclampsia/Eclampsia Among a Commercially Insured Population.

Abstract

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 incidence of MACE by race. Regression models were used to assess 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, 16.6% Black, 99.5% commercially insured, mean age 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White, 13.0% Black). Black patients had higher incidence of MACE than White patients at 1-yr post-delivery (2.7% vs 1.4%) with the majority within 14 days of delivery (Black: 58.7%; White: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with lower hazard of MACE for White patients within 14 days following delivery (HR 0.31, 95%CI: 0.21-0.46, p<0.001) but not Black patients (HR 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 following delivery.