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Peripartum cardiomyopathy (PPCM) is a heterogeneous condition characterized by heart failure and left ventricular (LV) dysfunction (LVEF < 45%) in the absence of an alternative cause and a previous diagnosis of cardiomyopathy. The Aboriginal population (Inuit, First Nations, Metis) of Canada often has barriers to healthcare access, which can lead to delays in diagnosis and appropriate treatment. The goals of our project are to describe PPCM in the Canadian population, and to determine if Canadian Aboriginal women have worse clinical outcomes than non-Aboriginal women.
A single-center retrospective review was completed using the Congestive Heart Failure (CHF) Clinic Database at St. Boniface Hospital in Winnipeg, Manitoba. Ethics approval was obtained from the University of Manitoba Research Ethics Board (REB) as well as St. Boniface Hospital REB, and a letter was written to the Assembly of Manitoba Chiefs. All female patients under the age of 55 years, assessed between July 1st, 2009 and July 31st, 2014 were screened for PPCM as defined in the 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of HF. Ethnic background was recorded based on patient self-report as taken from the patient’s hospital chart and the CHF Clinic Database. Demographics, symptoms of presentation, past medical history, medications at discharge, blood work, echocardiographic parameters and follow up information were collected. Statistical analysis was performed using Fisher’s Exact Test or Chi-square Test for categorical variables and Mann-Whitney Test for continuous variables.
A total of 177 women were screened, and 23 were included in the study (52% were Aboriginal). Baseline information can be found in Table 1. Aboriginal women were found to have higher rates of gravidity and parity, and higher incidence of tobacco smoking than non-Aboriginal women. Aboriginal women were more likely to be discharged on a diuretic. Other clinical characteristics and discharge medications did not significantly differ between the two groups. At diagnosis, Aboriginal women were more likely to have lower LVEF as well as a more dilated LV.
Peripartum cardiomyopathy is an important diagnosis to consider in the appropriate clinical setting. Our findings support that Aboriginal women with PPCM at this single-center are more likely to present with lower LVEF and a more dilated LV, as well as require more symptomatic management. This is the first description of PPCM in the Canadian population, and the first contrast of the disease in Aboriginal and non-Aboriginal women.