Stress Cardiomyopathy During COVID-19 Pandemic

Quick Takes

  • Incidence of stress cardiomyopathy among patients with acute coronary syndrome was higher during the COVID-19 pandemic compared to historical controls in 2018 and 2019.
  • Length of stay was longer in patients with stress cardiomyopathy during the pandemic compared to the pre-COVID-19 periods, with no difference in mortality or 30-day re-hospitalization rates.

Study Questions:

What is the incidence of stress (Takotsubo) cardiomyopathy during the coronavirus disease 2019 (COVID-19) pandemic in comparison to historical cohorts, and are the outcomes different?

Methods:

This was a retrospective analysis of all patients presenting with acute coronary syndrome (ACS) at two hospitals in Northeast Ohio across four separate time periods. The study group included patients with stress cardiomyopathy admitted between March 1 and April 30, 2020 (i.e., COVID-19 period) and control group included patients admitted from March 1 to April 30, 2018; January 1 to February 28, 2019; March 1 to April 30, 2019; and January 1 to February 29, 2020 (i.e., pre-COVID-19 period). Takotsubo cardiomyopathy was diagnosed in accordance with the international Takotsubo diagnostic criteria of 2014. Incidence of stress cardiomyopathy was captured across the COVID-19 and pre-COVID-19 time periods. All patients with stress cardiomyopathy during the COVID-19 pandemic had a negative COVID-19 test.

Results:

A total of 1,914 patients with ACS were included in the study: 1,656 in the pre-COVID-19 period and 258 patients during the COVID-19 period. Incidence of stress cardiomyopathy was significantly higher among patients presenting with ACS during the COVID-19 pandemic, with a total of 20 (7.8%) patients compared with pre-COVID-19 periods (number of patients ranging from 5-12, proportion range 1.5-1.8%). There were no significant differences in baseline characteristics of patients with stress cardiomyopathy in the pre-COVID-19 and COVID-19 periods, with the exception of a lower incidence of hypertension and lower peak troponin levels during the COVID-19 pandemic. During the pandemic, patients with stress cardiomyopathy had a longer length of stay (8 days vs. 4-5 days). Mortality and 30-day re-hospitalization rates among patients with stress cardiomyopathy were no different between the pre-COVID-19 and COVID-19 periods.

Conclusions:

Incidence of stress cardiomyopathy was higher during the COVID-19 pandemic when compared to historical controls. Length of stay was longer for patients with stress cardiomyopathy during the pandemic when compared to pre-pandemic time periods. Mortality and 30-day re-hospitalization rates were no different in the two time periods.

Perspective:

In this two-center retrospective cohort study, incidence of stress cardiomyopathy was higher among patients with ACS during the COVID-19 pandemic when compared to historical controls from 2018 and 2019. Notably, only patients who tested negative for COVID-19 were included, suggesting that the increased incidence reflects the indirect effect of pandemic-related stress. Limitations of the study include its small size and limited sensitivity of COVID-19 testing. These results support indirect harms of the pandemic among patients without the infection.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Acute Coronary Syndrome, Cardiomyopathies, Coronavirus, COVID-19, Heart Failure, Hypertension, Length of Stay, Secondary Prevention, Takotsubo Cardiomyopathy, Troponin


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