Cardiovascular and Non-cardiovascular 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

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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

OBJECTIVES: The purpose of this study was 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 and 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 analyzed 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 (N = 374 [15%]; HR: 1.78 [95% CI: 1.48-2.15], P < 0.0001), especially for cardiovascular (HR: 2.47 [95% CI: 1.81-3.39], P < 0.001) but also noncardiovascular (HR: 1.48 [95% CI: 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 [95% CI: 0.62-0.94], P = 0.012), which was attributable to lower rates of cardiovascular (HR: 0.61 [95% CI: 0.44-0.84], P = 0.002) but not non-cardiovascular (HR: 0.92 [95% CI: 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
JournalJACC: Advances
Volume3
Issue number2
DOIs
Publication statusPublished - 10 Jan 2024

Keywords / Materials (for Non-textual outputs)

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

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