Psychiatric disorders in Takotsubo syndrome: clinical profiles and outcomes

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Abstract Background Psychiatric disorders have been reported with a high prevalence in patients with Takotsubo syndrome (TTS). However, the clinical characteristics and outcomes of this specific patient subgroup remain underexplored. Purpose This study aimed to provide a detailed assessment of the clinical profiles and to evaluate both short- and long-term outcomes in patients with TTS and coexisting psychiatric disorders. Methods Patients with TTS were enrolled from the International Takotsubo (InterTAK) Registry. The primary outcome was the occurrence of TTS recurrence during follow-up, while secondary outcomes included mortality during hospitalization and at follow-up. Results Overall, 2650 patients with TTS were included in this study (median age 69.00 [60.00, 77.00] years, 89.5% female). Of these, 653 patients (24.6%) had psychiatric comorbidities. The overall incidence rate of recurrence was 14.3 cases per 1000 patient-years. After adjusting for confounders, a multivariable analysis showed that psychiatric disorders were not associated with an increased risk of in-hospital mortality in patients with TTS (OR, 0.59; 95% CI, 0.39–0.88). At long-term follow-up, there was no association between psychiatric disorders and cardiovascular mortality (HR, 1.12; 95% CI, 0.75–1.67). However, coexistent psychiatric disorders were independently associated with a higher rate of TTS recurrence (HR, 1.65; 95% CI, 1.07–2.54). This finding was confirmed by a propensity score matching analysis indicating a significantly higher recurrence rate of patients with psychiatric diseases (N=1306, OR, 2.65; 95% CI, 1.42–4.92; figure 1). Conclusion In this real-world study, psychiatric comorbidities had a prevalence of about 25% in TTS patients and were associated with a significantly higher risk of TTS recurrence at follow-up. The integration of follow-up strategies, stress-reduction interventions, and psychiatric counseling into the therapeutic management of TTS patients may represent a valuable approach to reduce the risk of recurrence and improve comprehensive patient care. However, further studies are needed to assess the effectiveness of tailored interventions in improving long-term outcomes for this patient population.Figure 1

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