The association between mental health disorders (MHD) and Takotsubo syndrome (TS) or Takotsubo cardiomyopathy, or “broken heart syndrome,” was identified among women aged 60 years and older with MHD complicated by transient cardiac symptoms, According to study findings published in The Journal of Women’s Health.
In this study conducted between 2007 and 2015, researchers used the US National Inpatient Sample (NIS) public database to compile discharge notes for 10.9 million patients. women age 60 and older who were hospitalized with severe cardiac symptoms. ST can mimic brief but severe left ventricular dysfunction, with potential escalation to systolic heart failure and ventricular arrhythmias that increase the risk of recurrent cardiac trauma.
Although the pathophysiology of TS is unknown and not fully understood, the researchers noted that TS can be caused by emotional or physical stress, as well as acute neurological diseases. Data are inconclusive as to whether MHDs instigate or are a consequence of a diagnosis of TS.
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MHDs were defined by conditions surrounding adjustment disorders, anxiety disorders, and mood disorders. The researchers evaluated 10,884,613 non-elective hospital admissions to identify MHD in patients with a primary (n=4749) or secondary (6702) diagnosis of TS, as well as when pooled. International Classification of Disease (ICD) codes and Classification Software (CCS) codes were used to diagnose TS and MHD, respectively. Two regression models showed the influence of sociodemographic, hospital level, and behavioral/lifestyle factors on the association between MHD and ST.
“Significant differences in sociodemographic, behavioral/lifestyle factors, and chronic conditions were observed by MHD status,” the researchers noted. “Compared with patients without MHD, a higher proportion of patients with MHD reported white race and were younger, current smokers, obese, and had a higher prevalence of substance use disorder and clinical conditions such as dyslipidemia, dementia, obstructive pulmonary disease. chronic and cancer. ”
The investigators concluded that MHDs were associated with an increased risk of TS (odds ratio, 1.25; 95% CI, 1.18-1.32). The CI increased for patients with a secondary diagnosis of TS (95% CI, 1.30-1.50). Although the association between TS and MHD requires further investigation, the researchers noted that the risk of TS was increased in patients with fit and mood disorderssuch as generalized anxiety disorder, and decreased among those with a history of attempted suicide and self-harm and those with personality disorders, including schizophrenia.
Limitations of this study included possible diagnostic errors due to the use of ICD codes and possible duplication of patients in the NIS. In addition, there was a lack of accessible data on cardiac examinations, medication regimens, laboratory results in making a diagnosis of ST, missing variables/covariates in determining external influences that potentially misrepresent the association between MHD and ST, and a lack of clinical predictors. of results.
“TS prevalence in the United States increased approximately fourfold between 2007 and 2015 among older women, with a higher prevalence among patients diagnosed with MHD,” the researchers noted. “Overall, this study found a positive association between MHD and TS. This association, which was not homogeneous across the spectrum of MHDs, was found to increase with the number of MHDs diagnosed. Further studies are needed to elucidate the underlying mechanisms linking MHD with TS.”
Reference
Appiah D, Noamesi AT, Osaji J, Bolton C, Nwabuo CC, Ebong IA. The Association of Mental Health Disorders with Takotsubo Syndrome (Broken Heart Syndrome) among Older Women. J Women’s Health. Published online March 3, 2022. doi:10.1089/jwh.2021.0557
This article originally appeared on Psychiatry Advisor
