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

Amelia Rudd; Graham Horgan; Hilal Khan; David Gamble; Jim McGowan; Arvind Sood; Ross McGeoch; John Irving; Jonathan Watt; Stephen Leslie; Mark C. Petrie; Chim C Lang; Nicholas L Mills; David E Newby; Dana Dawson

doi:10.1016/j.jacadv.2023.100797

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

Amelia Rudd, Graham Horgan, Hilal Khan, David Gamble, Jim McGowan, Arvind Sood, Ross McGeoch, John Irving, Jonathan Watt, Stephen Leslie, Mark C. Petrie, Chim C Lang, Nicholas L Mills, David E Newby, Dana Dawson^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

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 noncardiovascular (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 language	English
Article number	100797
Number of pages	10
Journal	Journal of the American College of Cardiology
Volume	3
Issue number	2
Early online date	10 Jan 2024
DOIs	https://doi.org/10.1016/j.jacadv.2023.100797
Publication status	Published - Feb 2024

Bibliographical note

Dr Dawson has received Chief Scientist Office Scotland award CGA-16-4 and the BHF Research Training Fellowship (FS/RTF/20/30009, for Ms Amelia Rudd). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Data Availability Statement

APPENDIX For supplemental tables and figures, please see the online version of this paper.

Keywords

cardiovascular
electronic data linkage
medication
mortality
myocardial infarction
takotsubo

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Cite this

Rudd, A., Horgan, G., Khan, H., Gamble, D., McGowan, J., Sood, A., McGeoch, R., Irving, J., Watt, J., Leslie, S., Petrie, M. C., Lang, C. C., Mills, N. L., Newby, D. E., & Dawson, D. (2024). Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo: Comparison with Myocardial Infarction and General Population. Journal of the American College of Cardiology, 3(2), Article 100797. https://doi.org/10.1016/j.jacadv.2023.100797

Rudd, A, Horgan, G, Khan, H, Gamble, D, McGowan, J, Sood, A, McGeoch, R, Irving, J, Watt, J, Leslie, S, Petrie, MC, Lang, CC, Mills, NL, Newby, DE & Dawson, D 2024, 'Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo: Comparison with Myocardial Infarction and General Population', Journal of the American College of Cardiology, vol. 3, no. 2, 100797. https://doi.org/10.1016/j.jacadv.2023.100797

@article{f1ff3c59dac14d8bafd8521f13240e42,

title = "Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo: Comparison with Myocardial Infarction and General Population",

abstract = "BackgroundTakotsubo syndrome is an increasingly common cardiac emergency with no known evidence-based treatment.ObjectivesThe purpose of this study was to investigate cardiovascular mortality and medication use after takotsubo syndrome.MethodsIn 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.ResultsOf 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 noncardiovascular (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.ConclusionsIn patients with takotsubo syndrome, cardiovascular mortality is the leading cause of death, and this is not associated with cardiovascular therapy use.",

keywords = "cardiovascular, electronic data linkage, medication, mortality, myocardial infarction, takotsubo",

author = "Amelia Rudd and Graham Horgan and Hilal Khan and David Gamble and Jim McGowan and Arvind Sood and Ross McGeoch and John Irving and Jonathan Watt and Stephen Leslie and Petrie, {Mark C.} and Lang, {Chim C} and Mills, {Nicholas L} and Newby, {David E} and Dana Dawson",

note = "Dr Dawson has received Chief Scientist Office Scotland award CGA-16-4 and the BHF Research Training Fellowship (FS/RTF/20/30009, for Ms Amelia Rudd). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. ",

year = "2024",

month = feb,

doi = "10.1016/j.jacadv.2023.100797",

language = "English",

volume = "3",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "2",

}

TY - JOUR

T1 - Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo

T2 - Comparison with Myocardial Infarction and General Population

AU - Rudd, Amelia

AU - Horgan, Graham

AU - Khan, Hilal

AU - Gamble, David

AU - McGowan, Jim

AU - Sood, Arvind

AU - McGeoch, Ross

AU - Irving, John

AU - Watt, Jonathan

AU - Leslie, Stephen

AU - Petrie, Mark C.

AU - Lang, Chim C

AU - Mills, Nicholas L

AU - Newby, David E

AU - Dawson, Dana

N1 - Dr Dawson has received Chief Scientist Office Scotland award CGA-16-4 and the BHF Research Training Fellowship (FS/RTF/20/30009, for Ms Amelia Rudd). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

PY - 2024/2

Y1 - 2024/2

N2 - BackgroundTakotsubo syndrome is an increasingly common cardiac emergency with no known evidence-based treatment.ObjectivesThe purpose of this study was to investigate cardiovascular mortality and medication use after takotsubo syndrome.MethodsIn 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.ResultsOf 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 noncardiovascular (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.ConclusionsIn patients with takotsubo syndrome, cardiovascular mortality is the leading cause of death, and this is not associated with cardiovascular therapy use.

AB - BackgroundTakotsubo syndrome is an increasingly common cardiac emergency with no known evidence-based treatment.ObjectivesThe purpose of this study was to investigate cardiovascular mortality and medication use after takotsubo syndrome.MethodsIn 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.ResultsOf 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 noncardiovascular (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.ConclusionsIn 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

SN - 0735-1097

VL - 3

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 2

M1 - 100797

ER -

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

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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