The incidence of stress cardiomyopathy, also known as takotsubo syndrome or broken heart syndrome, increased in patients with ACS during the COVID-19 pandemic compared with before the pandemic, researchers found.
“The fact that stress cardiomyopathy happens with heightened stress is not new,” Ankur Kalra, MD, FACP, FACC, FSCAI, associate professor of medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and staff interventional cardiologist in the department of cardiovascular medicine, Heart, Vascular and Thoracic Institute at Cleveland Clinic, told Healio. “It is important because it’s an objective barometer of measuring stress in the community. You and I can say that we’re stressed, but how can we objectively measure it? Now you have a condition that you know has a direct causal association and a relationship with stress, has been documented and proven, and there is a body of medical literature that exists around it.”
Patients with ACS
In this study published in JAMA Network Open, Ahmad Jabri, MD, resident in the department of internal medicine at Cleveland Clinic Akron General, and colleagues analyzed data from 1,914 patients who presented with ACS during the following periods:
- March to April 2018 (n = 390; median age, 67 years; 65% men);
- January to February 2019 (n = 309; median age, 67 years; 68% men);
- March to April 2019 (n = 679; median age, 67 years; 68% men);
- January to February 2020 (n = 278; median age, 66 years; 62% men); and
- March to April 2020 (n = 258; median age, 67 years; 68% men).
The incidence of stress cardiomyopathy was assessed before the COVID-19 pandemic (before February) and during the pandemic.
The incidence of stress cardiomyopathy significantly increased from pre-pandemic timelines (incidence proportion range, 1.5% to 1.8%) to the COVID-19 period (incidence proportion, 7.8%). The rate ratio was 4.58 when the COVID-19 pandemic period was compared with the combined pre-pandemic period (95% CI, 4.11-5.11; P < .001).
All patients who presented with ACS during the pandemic tested negative for COVID-19.
The median hospital length of stay was longer for patients with stress cardiomyopathy during the pandemic (8 days) compared with March to April 2018 (4 days), January to February 2019 (5 days), March to April 2019 (4 days) and January to February 2020 (5 days; P = .006).
Patients during the COVID-19 period and before the pandemic did not have significant differences in mortality (5% vs. 3.6% respectively) and 30-day rehospitalization (22.2% vs. 21.4%, respectively).
‘Self-care is extremely important’
“The implications are for the clinicians to share the messages with their patients that if you’re not feeling well, you should get in touch with the emergency department or come to the hospital,” Kalra said in an interview. “That’s No. 1. Then No. 2 is that self-care is extremely important when times are stressful. That’s a very important message. Take care of the body, take care of the mind, take care of the spirit and build inner resilience.”
Kalra also mentioned that further research is needed in this area. He said, “It would be interesting to see if other regions or other states in the country report similar incidence. That would be fascinating. Clearly our limitation is that we were not sure if this was extrapolatable to other regions, other states or other countries.”
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For more information:
Ankur Kalra, MD, can be reached at email@example.com; Twitter: @ankurkalramd.