Risk of Hospital Readmission High for “Broken Heart” Syndrome
Physicians Should Monitor Takotsubo Patients Closely, Make Detailed Discharge Plans
Though not having a heart attack, patients with “broken heart” syndrome still face considerable risk of hospital readmission and in-hospital death. This is the main finding of a study led by researchers at NYU School of Medicine and published online October 2 in the European Heart Journal—Quality of Care and Clinical Outcomes.
Takotsubo syndrome, also called “broken heart” syndrome, and heart attack have common symptoms, including chest pain and difficulty breathing. Typically brought on by stressful events, Takotsubo syndrome involves a sudden weakening of the heart muscle not caused by major arterial blockage, whereas heart attack results from severe blockage of an artery. Similarities between the two conditions make diagnosis challenging for physicians.
Based on analyses of 61,412 men and women with the syndrome, the research team found that 12 percent of such patients were hospitalized within 30 days of discharge, compared to 17 percent of patients who had a heart attack (acute myocardial infarction). The research team also found that, among patients readmitted to hospital within 30 days, nearly 4 percent of patients with Takotsubo syndrome and 7 percent of patients with acute myocardial infarction died during their stay.
“Our findings show that Takotsubo syndrome still presents considerable risk to patients after they’re initially discharged from the hospital,” says Harmony Reynolds, MD, an associate professor of medicine in the Leon H. Charney Division of Cardiology at NYU Langone Health and senior investigator of the study. “Even though the heart muscle recovers full function in survivors, there are lasting effects on the body. Physicians should monitor Takotsubo patients carefully.”
Although commonly presumed to be temporary, Takotsubo syndrome often causes patients to experience other cardiac events, say the authors. As part of their study, researchers found that the most common cause for patient readmission was heart failure, a buildup of fluid in the lungs and the body due to loss of the heart’s ability to pump blood properly—11 percent of patients with Takotsubo syndrome and 13 percent of patients who experienced acute myocardial infarction had this complication.
“Takotsubo patients should be given a detailed discharge plan and counseled on potential reasons to revisit their doctor, such as difficulty breathing or swelling of the legs,” says study co-lead investigator and interventional cardiologist Nathaniel Smilowitz, MD, an assistant professor of medicine at NYU Langone. “These are very sick patients who need close follow-up.”
How the Study Was Conducted
For the study, researchers examined the medical records of patients with Takotsubo syndrome and 3,470,011 patients with acute myocardial infarction based on data from the United States Nationwide Readmission Database between 2010 and 2014. They also reviewed information about the reason for hospital readmission within 30 days, in-hospital death rates, and the presence of other health issues, including diabetes, high blood pressure, and obesity. Researchers say the study is the first of its kind to look at readmission rates in Takotsubo syndrome patients of all ages within the United States.
Among the study’s key findings, patients with Takotsubo syndrome were younger and more likely to be women, compared with patients with acute myocardial infarction. Those with Takotsubo syndrome also had fewer risk factors for heart disease, such as diabetes and obesity, but were more likely to have additional illnesses not related to the heart, including depression, rheumatoid arthritis, and chronic pulmonary disease.
“The challenge for the healthcare community is that ‘broken heart’ syndrome is not as well understood,” says study co-lead investigator Anais Hausvater, MD, a postdoctoral fellow at NYU Langone. “To help these patients, physicians need to be more aware of this condition.”
Toward this end, the researchers have established a research registry for Takotsubo syndrome. Funding support for the study was provided by NYU Langone. Dr. Smilowitz was also supported by National Institutes of Health National Heart, Lung, and Blood Institute grant T32 HL098129.