Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo: Comparison With Myocardial Infarction and General Population

Amelia E. Rudd, Graham Horgan, Hilal Khan, David T. Gamble, Jim McGowan, Arvind Sood, Ross McGeoch, John Irving, Jonathan Watt, Stephen J. Leslie, Mark Petrie, Chim Lang, Nicholas L. Mills, David E. Newby, Dana K. Dawson (Lead / Corresponding author)

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Abstract

BACKGROUND: Takotsubo syndrome is an increasingly common cardiac emergency with no known evidence-based treatment.

OBJECTIVES: To investigate cardiovascular mortality and medication use after takotsubo syndrome.

METHODS: In a case-control study, all patients with takotsubo syndrome in Scotland between 2010-2017 (n=620) were age, sex and geographically matched to individuals in the general population (1:4, n=2,480) and contemporaneous patients with acute myocardial infarction (1:1, n=620). Electronic health record data linkage of mortality outcomes and drug prescribing were analysed using Cox proportional hazard regression models.

RESULTS: Of the 3,720 study participants (mean age, 66 years; 91% women), 153 (25%) patients with takotsubo syndrome died over the median of 5.5 years follow up. This exceeded mortality rates in the general population [374 (15%)]; hazard ratio [HR] 1.78 [95% confidence interval 1.48-2.15], P<0.0001), especially for cardiovascular (HR 2.47, [1.81-3.39], P<0.001) but also non-cardiovascular (HR 1.48 [1.16-1.87], P=0.002) deaths. Mortality rates were lower for patients with takotsubo syndrome than those with myocardial infarction (31%, 195/620; HR 0.76 [0.62-0.94], P=0.012), which was attributable to lower rates of cardiovascular (HR 0.61 [0.44-0.84], P=0.002) but not non-cardiovascular (HR 0.92 [0.69-1.23], P=0.59) deaths. Despite comparable medications use, cardiovascular therapies were consistently associated with better survival in patients with myocardial infarction but not in those with takotsubo syndrome. Diuretic (P=0.01), anti-inflammatory (P=0.002) and psychotropic (P<0.001) therapies were all associated with worse outcomes in patients with takotsubo syndrome.

CONCLUSIONS: In patients with takotsubo syndrome, cardiovascular mortality is the leading cause of death, and this is not associated with cardiovascular therapy use.
Original languageEnglish
Article number100797
Number of pages10
JournalJACC: Advances
Volume3
Issue number2
Early online date10 Jan 2024
DOIs
Publication statusPublished - Feb 2024

Keywords

  • takotsubo
  • mortality
  • cardiovascular
  • medication
  • electronic data linkage
  • myocardial infarction

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