Long-term prognosis in Takotsubo syndrome compared to heart failure: observations from a global federated research...

To compare long-term outcomes of patients with Takotsubo syndrome (TTS) and heart failure (HF).

This retrospective observational study used the TriNetX global federated research network. Adult patients (≥18 years) discharged with a diagnosis of TTS (ICD-10-CM I51.81) or HF (I50.x) between 2018 and 2022 were identified. Primary outcomes were 3-year risk of all-cause death, major adverse cardiovascular events (MACE; myocardial infarction or ischaemic stroke), and acute HF. Secondary outcomes included myocardial infarction, ischaemic stroke, ventricular arrhythmias (ventricular tachycardia), malignant arrhythmias (ventricular fibrillation or cardiac arrest), and new-onset atrial fibrillation (AF). Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) before and after 1:1 propensity score matching (PSM). Subgroup analyses were performed by HF phenotype, age (≥65 vs <65 years), and mental health status.

The study included 2240 patients with TTS (mean age 62.6 ± 17.3 years; 73.7% female) and 265 564 patients with HF (69.3 ± 14.7 years; 45.8% female). After PSM, TTS was associated with a lower risk of acute HF (HR 0.622, 95% CI 0.539-0.717), ventricular arrhythmias (HR 0.637, 95% CI 0.441-0.919), malignant arrhythmias (HR 0.656, 95% CI 0.571-0.754), new-onset AF (HR 0.672, 95% CI 0.517-0.875), and myocardial infarction (HR 0.818, 95% CI 0.687-0.974), with no significant differences in the remaining outcomes. Differences were greater when TTS was compared with heart failure with reduced ejection fraction.

TTS is associated with lower risk of adverse events than HF. Further research is needed on mental health in its pathogenesis and prognosis.