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Observational Study
. 2017 Sep-Oct;58(5):527-532.
doi: 10.1016/j.psym.2017.04.008. Epub 2017 Apr 20.

Pre-existing Psychiatric Illness is Associated With Increased Risk of Recurrent Takotsubo Cardiomyopathy

Arash Nayeri  1 , Eric Rafla-Yuan  2 , Eric Farber-Eger  3 , Marcia Blair  3 , Boback Ziaeian  4 , Martin Cadeiras  4 , John A McPherson  3 , Quinn S Wells  3
Affiliations
Observational Study

Pre-existing Psychiatric Illness is Associated With Increased Risk of Recurrent Takotsubo Cardiomyopathy

Arash Nayeri et al. Psychosomatics. 2017 Sep-Oct.

Abstract

Background: The increased prevalence of psychiatric illness among patients with takotsubo cardiomyopathy (TC) has been previously described.

Objectives: We sought to assess the effect of pre-existing psychiatric illness on clinical outcomes following the diagnosis of TC.

Methods: Adults diagnosed with TC at Vanderbilt University Medical Center between 1999 and 2015 were included in the study. Medical records were retrospectively reviewed to identify any pre-existing mood, anxiety, or schizophrenia-spectrum illness before TC presentation. Multivariable logistic regression was used to test for independent association of pre-existing psychiatric illness with 30-day mortality and recurrent TC; Cox proportional hazard analysis was used to evaluate for association with long-term mortality.

Results: Among 306 patients diagnosed with TC during the study period, 114 (37%) had a pre-existing psychiatric illness. In all, 43 (14%) and 88 (29%) patients died within 30 days of index diagnosis and as of last medical record review, respectively. Of the 269 who survived their index hospitalization, 19 (7%) had a confirmed recurrent episode of TC. In multivariable analyses, pre-existing psychiatric illness was not associated with increased 30-day (P = 0.320) or long-term (P = 0.621) mortality. Pre-existing psychiatric illness was associated with higher risk of recurrent TC (odds ratio = 7.44, 95% CI: 2.30-24.01, P < 0.001).

Conclusions: Pre-existing psychiatric illness was associated with an increased risk of recurrent TC. No significant association was noted between pre-existing psychiatric illness and survival.

Keywords: Psychiatric illness; Recurrence; Stress cardiomyopathy; Survival; Takotsubo.

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Figures

FIGURE 1.
FIGURE 1.
Spectrum of Psychiatric Illness in Takotsubo Cardiomyopathy. A Total of 114 Patients Accounted for a total of 151 Mood, Anxiety, and Schizophrenia-Spectrum Diagnoses.
FIGURE 2.
FIGURE 2.
Kaplan-Meier Survival and Temporal Distribution of Recurrence in Patients Following Takotsubo Cardiomyopathy. Long-term Mortality Represents Cumulative Mortality from Index Diagnosis to the Date of Last Medical Record Review.
See this image and copyright information in PMC

Comment in

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