Heart Failure Incidence and Prevalence Trends Among U.S. Women with Prior Adverse Pregnancy Outcomes, 2013-2023.
Adverse pregnancy outcomes (APOs) confer long-term cardiovascular risk, yet population-level temporal trends in heart failure (HF) burden among APO-exposed women in the United States remain uncharacterized.
We used the TriNetX U.S. Collaborative Network (64 U.S. health care organizations; n = 979,178 women aged 15-60 years with ≥1 documented APO at delivery) to calculate annual HF incidence proportion and period prevalence from 2013 through 2023, stratified by 5-year age band and self-reported race/ethnicity. HF was identified by International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code I50; a prewindow lookback distinguished the incident from prevalent cases.
HF incidence proportion rose 2.70-fold (0.782-2.110 per 1,000), and prevalence increased 3.20-fold (0.39-1.26%) from 2013 to 2023. By 2023, women aged 15-19 years had an HF incidence of 1.529 per 1,000, exceeding the 2013 incidence of women a decade older (30-34 years: 0.916 per 1,000) (7.7-fold increase). Incidence declined 10.7% in 2020, whereas prevalence continued to rise (0.74-0.81%), before incidence rebounded 31.1% in 2021. AI/AN women maintained the highest absolute incidence throughout (5.845 per 1,000 in 2013; 5.467 per 1,000 in 2023). Black/AA women showed a 2.1-fold increase (1.673-3.534 per 1,000), maintaining a 2.0- to 3.2-fold excess over White women at all time points. Native Hawaiian/Other Pacific Islander women had the largest incidence-prevalence divergence: a 5.8-fold prevalence increase (0.40-2.33%) against a near-stable incidence proportion.
HF burden increased substantially across all age groups and racial categories among APO-exposed U.S. women from 2013 to 2023.
We used the TriNetX U.S. Collaborative Network (64 U.S. health care organizations; n = 979,178 women aged 15-60 years with ≥1 documented APO at delivery) to calculate annual HF incidence proportion and period prevalence from 2013 through 2023, stratified by 5-year age band and self-reported race/ethnicity. HF was identified by International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code I50; a prewindow lookback distinguished the incident from prevalent cases.
HF incidence proportion rose 2.70-fold (0.782-2.110 per 1,000), and prevalence increased 3.20-fold (0.39-1.26%) from 2013 to 2023. By 2023, women aged 15-19 years had an HF incidence of 1.529 per 1,000, exceeding the 2013 incidence of women a decade older (30-34 years: 0.916 per 1,000) (7.7-fold increase). Incidence declined 10.7% in 2020, whereas prevalence continued to rise (0.74-0.81%), before incidence rebounded 31.1% in 2021. AI/AN women maintained the highest absolute incidence throughout (5.845 per 1,000 in 2013; 5.467 per 1,000 in 2023). Black/AA women showed a 2.1-fold increase (1.673-3.534 per 1,000), maintaining a 2.0- to 3.2-fold excess over White women at all time points. Native Hawaiian/Other Pacific Islander women had the largest incidence-prevalence divergence: a 5.8-fold prevalence increase (0.40-2.33%) against a near-stable incidence proportion.
HF burden increased substantially across all age groups and racial categories among APO-exposed U.S. women from 2013 to 2023.
Authors
Jaamour Jaamour, Tolu-Akinnawo Tolu-Akinnawo, Anuforo Anuforo, Guzman Guzman, Awoyemi Awoyemi
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