Associations Between Acute Heat Exposure and Hospitalization for Takotsubo Syndrome in the State of California, 2006 to 2019

BACKGROUND: Takotsubo Syndrome (TTS), a transient cardiac condition often triggered by physical or emotional stress, may be sensitive to extreme environmental exposures. Although psychosocial factors are well-established triggers, limited evidence exists on the role of temperature extremes, particularly heat waves, in precipitating TTS events. We investigated the association between short-term heat wave exposure and TTS hospitalizations in California. METHODS: code I51.81, using 4 case definitions incorporating primary versus secondary diagnosis and procedural criteria. Heatwaves were defined as ≥2 consecutive days exceeding the ZIP code-specific 95th percentile of daily maximum temperature. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% CIs, adjusting for dew point temperature, day of year, and holidays. RESULTS: We identified 5018 TTS hospitalization events. Heatwave exposure was associated with significantly elevated odds of TTS hospitalization, particularly at lag days 4-6 (OR for lag, 5 1.382 95% CI, 1.167-1.636; OR for lag, 4-6 1.300 95% CI, 1.142-1.479). Subgroup analyses showed stronger associations among women and individuals ≤65 years. On average, peak heat wave temperatures were 4.21 °C higher than pre-heat wave days. CONCLUSIONS: Short-term exposure to heat waves is associated with increased risk of TTS hospitalizations. These findings underscore the need for targeted surveillance and preventative strategies during periods of extreme heat, particularly among susceptible subpopulations.