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Takotsubo cardiomyopathy consistently treated incorrectly, study finds

Heart treatments given to patients with takotsubo cardiomyopathy do not protect them and the condition is not being treating correctly, according to a new study comparing these patients with myocardial infarction patients and the general population.

Published in the journal JACC: Advances and funded by the British Heart Foundation, the researchers analysed health records from 3,720 people in Scotland to investigate cardiovascular mortality and medication use after takotsubo cardiomyopathy – for which there is no expert consensus on treatment.

They found that takotsubo cardiomyopathy patients were prescribed the same medication as patients with myocardial infarction despite having unobstructed coronary arteries.

Cardiovascular therapies were consistently associated with better survival in patients with myocardial infarction but not in those with takotsubo syndrome.

These patients were found to be more likely to die than the general population and just as vulnerable to dying as patients who had suffered a myocardial infarction.

A total of 153 (25%) patients with takotsubo cardiomyopathy died over the median of 5.5 years follow-up. This exceeded mortality rates in the general population (N = 374 [15%]; HR: 1.78 [95% CI: 1.48-2.15], P < 0.0001), especially for cardiovascular (HR: 2.47 [95% CI: 1.81-3.39], P < 0.001) but also non-cardiovascular (HR: 1.48 [95% CI: 1.16-1.87], P = 0.002) deaths.

Mortality rates were lower for patients with takotsubo cardiomyopathy than those with myocardial infarction (31%, 195/620; HR: 0.76 [95% CI: 0.62-0.94], P = 0.012), which was attributable to lower rates of cardiovascular (HR: 0.61 [95% CI: 0.44-0.84], P = 0.002) but not non-cardiovascular (HR: 0.92 [95% CI: 0.69-1.23], P = 0.59) deaths.

The only cardiovascular therapy associated with lower mortality in patients with takotsubo cardiomyopathy was angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy (P = 0.0056), but unlike in myocardial infarction, cardiovascular medications were not consistently associated with better long-term survival.

Professor Dana Dawson, professor of cardiovascular medicine and consultant cardiologist at the University of Aberdeen and Aberdeen Royal Infirmary, who led the study, said: ‘Our data shows quite starkly that we are not treating this condition correctly. It is vital that we identify precise ways to treat this unique group of people, and that is what we plan to do as we continue our research.

‘This study has identified one drug as a potential breakthrough with promising therapeutic benefit, however, further research is needed to establish if this is the key to treating this devastating illness.’

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