Differences in Obstetric and Cardiac Outcomes of Pregnant CHD Patients by Rurality [ID 1628]

INTRODUCTION: The objective was to examine the association between patient residence (urban or rural), and both major adverse cardiac events (MACEs) and adverse pregnancy outcomes (APOs) in pregnant women with congenital heart disease (CHD). METHODS: A retrospective cohort study from 2016–2021 HCUP-NIS (National Inpatient Sample) database was conducted using pregnant Americans with CHD and their location (urban or rural). HCUP-NIS represents 96% of the American population with over nine million admissions annually. The primary outcomes were MACEs and APOs. Multivariate logistic regression with survey procedures and weighted odds ratios were used to represent national estimates. RESULTS: The weighted sample represented 24,295 (n=4,859) patients, of which 20,840 (n=4,168) were in urban settings and 3,455 (n=691) in rural settings. Rurality was associated with higher odds of MACE with a trend towards significance (adjusted odds ratio [aOR] 1.18; 95% CI, 0.98–1.41; P =.08), and associated with lower odds of APO (aOR 0.76; 95% CI, 0.63–0.91; P =.003). Stratification by complexity showed rural patients with moderate CHD to have highest odds of MACE (OR 1.92; 95% CI, 0.92–1.55; P =.19) and rural patients with severe CHD to have lowest odds of APO (OR 0.60; 95% CI, 0.33–1.09; P =.09). An unadjusted model with an interaction term showed no effect modification of patient rurality by complexity of MACE ( P =.66) or APO ( P =.60). CONCLUSIONS/IMPLICATIONS: Pregnant patients with CHD living in rural settings have an increased odds of MACE, with a trend towards significance, and decreased odds of APO, possibly due to referrals of highest risk patients to urban centers. These results support the need for multidisciplinary obstetrical programs for CHD patients in rural settings, either in person or through telehealth.