TY - JOUR
T1 - Cardiovascular and Non-cardiovascular Prescribing and Mortality After Takotsubo - Comparison With Myocardial Infarction and General Population
AU - Rudd, Amelia E.
AU - Horgan, Graham
AU - Khan, Hilal
AU - Gamble, David T.
AU - Mcgowan, Jim
AU - Sood, Arvind
AU - Mcgeoch, Ross
AU - Irving, John
AU - Watt, Jonathan
AU - Leslie, Stephen J.
AU - Petrie, Mark
AU - Lang, Chim
AU - Mills, Nicholas L.
AU - Newby, David E.
AU - Dawson, Dana K.
PY - 2024/1/10
Y1 - 2024/1/10
N2 - 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.
AB - 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.
KW - cardiovascular
KW - electronic data linkage
KW - medication
KW - mortality
KW - myocardial infarction
KW - takotsubo
U2 - 10.1016/j.jacadv.2023.100797
DO - 10.1016/j.jacadv.2023.100797
M3 - Article
C2 - 38774915
SN - 2772-963X
VL - 3
JO - JACC: Advances
JF - JACC: Advances
IS - 2
M1 - 100797
ER -