Morbidity After Takotsubo Syndrome: A Report From the Scottish Takotsubo Registry

Takotsubo syndrome is a cardiac emergency characterised by left ventricular systolic dysfunction mimicking an acute myocardial infarction. The extent and causes of subsequent morbidity following recovery after an acute takotsubo syndrome episode are unknown. In a case-control study, all patients with takotsubo syndrome (n=620) diagnosed in Scotland between January 2010 and December 2017 were age, sex and geographically matched to contemporaneous general Scottish population control subjects (n=2480) in a ratio of 1:4 and patients with myocardial infarction (n=620) in a ratio of 1:1. Subsequent hospital admissions were obtained from the Public Health Scottish Morbidity Records. Of the total 12,873 hospitalisations, there were 762/1,000 person-years for patients with takotsubo syndrome, 525/1,000 person-years for general Scottish population controls and 757/1,000 person-years for patients with myocardial infarction. In comparison to general population, patients with takotsubo syndrome had higher admissions for cardiovascular causes (hazard ratio 4.26 [95% confidence interval 3.53-5.15]) including myocardial infarction (3.11 [2.11-4.57]), heart failure (4.92 [3.06-7.93]), arrhythmia (3.56 [2.55-4.98]) and stroke (1.88 [1.16-3.03]). There were also excess admissions for mental health (3.74 [2.35-5.94]), pulmonary (3.49 [2.61-4.66]), neurological, infectious, gastro-intestinal, and peripheral vascular disease causes. In comparison to patients with myocardial infarction, patients with takotsubo syndrome had lower admissions for cardiovascular causes (0.58 [0.49-0.70]) including myocardial infarction (0.27 [0.19-0.38]), heart failure (0.55 [0.37-0.83]) and arrhythmia (0.65 [0.47-0.91]) but they were similar for stroke (0.70 [0.41-1.18]); they also had fewer admissions for renal (0.58 [0.41-0.81], infectious (0.75 [0.58-0.97]) and diabetes/endocrine (0.30 [0.13-0.70]) but higher for gastro-intestinal (1.34 [1.02-1.77]) causes. Takotsubo syndrome is associated with substantial morbidity and recurrent hospitalisations highlighting an increased vulnerability, a need for better discharge advice, clinical follow-up and preventative strategies.