Prior use of primary health care services in patients who have experienced Takotsubo Cardiomyopathy

Problem

Takotsubo cardiomyopathy (Tako-tsubo) is an increasingly recognised cause of acute heart failure. It presents similarly to a myocardial infarction (MI), however Tako-tsubo angiography may show no sign of obstructive cardiac disease. On imaging, ‘ballooning’ of the apical myocardium can be seen, which is a typical finding in Tako-tsubo. Recent evidence shows that Tako-tsubo may be psychosomatically linked. This interference may be explored through assessing primary care consultation habits and health care usage.

Approach

We aimed to compare consultation habits over a 5-year period and the prevalence of past psychiatric morbidity in patients with Tako-tsubo against patients who have suffered a myocardial infarction (MI).Patients who have suffered from Tako-tsubo or MI and presented to Aberdeen Royal Infirmary since 2011 were invited to participate. Those who accepted gave written consent to allow a researcher to examine their medical records. Total health care usage was assessed and compared between the two groups, as well as the number of psychiatric or cardiology related consultations in the two groups. Prevalence of past psychiatric and cardiology related medical events were also compared. Data were analysed with Mann Whitney and Chi-squared tests as appropriate (significance assumed at p<0.025).

Findings

Twenty-two cases of Tako-tsubo were compared with 14 cases of MI. Patients were gender and age matched as much as possible (86% female in Tako-tsubo group vs 79% in the MI group were female). The median age at which the cardiac event occurred in the Tako-tsubo group of patients was 61 years, compared with 65 in the MI control group. Patients with Tako-tsubo had a significantly higher healthcare usage relating to total consultations (p<0.001), investigations performed (p=0.022), referrals (p<0.001) and diagnoses (p=0.021) over the preceding 5 years. Prevalence of psychiatric disorders did not differ significantly between groups.

Consequences

Patients with Tako-tsubo have a higher dependence on primary healthcare before their medical event. Further research is required to determine whether treatment methods focusing on psychopathology benefit patients after the Tako-tsubo event.