Rates of Stress Cardiomyopathy Rising During COVID-19 Pandemic

Ankur Karla, MD

While the impact of the coronavirus disease 2019 (COVID-19) on overall and cardiovascular health has been widely discussed, new research is detailing the impact of mental stress from the pandemic is having on heart health.

A retrospective analysis of data from 2 hospitals within the Cleveland Clinic health system, results of the study indicated rates of stress cardiomyopathy were more than 4 times greater than the pre-COVID-19 rates.

“The COVID-19 pandemic has brought about multiple levels of stress in people’s lives across the country and world. People are not only worried about themselves or their families becoming ill, they are dealing with economic and emotional issues, societal problems and potential loneliness and isolation,” said lead investigator Ankur Kalra, MD, a cardiologist in the Sections of Invasive and Interventional Cardiology and Regional Cardiovascular Medicine at the Cleveland Clinic, in a statement. “The stress can have physical effects on our bodies and our hearts, as evidenced by the increasing diagnoses of stress cardiomyopathy we are experiencing.”

By most accounts, the ongoing COVID-19 pandemic has reshaped life in the US and throughout the world for the foreseeable future. Despite less than a year elapsing since the initial outbreak began, mountains of data have been collected and disseminated related to the impact of COVID-19 on various aspects of a person’s health.

One of the most universal impacts of COVID-19, has been an increase in stress. From impact on sleep to overall psychological health, the effects of additional stress from COVID-19 has been felt by many patients and been the topic of dozens of studies since the outbreak began. Kalra and colleagues from the Cleveland Clinic hoped to add to the understanding of this impact by assessing the incidence of stress cardiomyopathy, also known as Takotsubo cardiomyopathy, during the COVID-19 pandemic compared against historical rates.

Using electronic medical record data obtained from patients admitted to either the Cleveland Clinic Main Campus or Cleveland Clinic Akron General hospitals between March 1-April 30, 2020, investigators identified a cohort of 258 patients presenting with acute coronary syndromes and without COVID-19, as confirmed by reverse transcription–polymerase chain reaction tests. For the purpose of their analysis, investigators created 4 control cohorts of patients admitted from March 1-April 30, 2018, January 1-February 28, 2019, March 1-April 30, 2019, and January 1-February 29, 2020 for comparison.

In total, the retrospective cohort study included 1914 patients presenting with acute coronary syndrome, including 1656 who presented pre-COVID-19. Of the 1656 pre-COVID-19 patients, 290 were admitted from March-April 2018, 309 were admitted from January-February 2019, 679 were admitted from March-April 2019, and 278 were admitted from January-February 2020. Investigators pointed out there were no statistically significant differences in median age (pre–COVID-19: 67 [59-74] years vs COVID-19: 67 [57-75] years; P=.56) or sex (pre–COVID-19: 1064 [66.1%] men vs COVID-19: 175 [67.8%] men; P=.43) between the groups.

During the COVID-19 period, a total of 20 (7.8%) patients presented with stress cardiomyopathy, which represents an increase compared to the pre-COVID-19 period. In comparison, incidence of stress cardiomyopathy during the pre-COVID-19 periods ranged from 5-12 patients. Based on the results of the analysis, investigators calculate the rate ratio during the COVID-19 period to be 4.58 times greater than during the pre-COVID-19 time periods (RR, 4.58; 95% CI, 4.11-5.11; P <.001).

Of note, patients presenting with stress cardiomyopathy during the pandemic had a longer median hospital length of stay than those hospitalized in pre-COVID-19 periods. Specifically, patients during the COVID-19 period had a median length of stay of 8 (IQR, 6-9) days compared to 4 (3-4) days for March-April 2018, 5 (3-6) days for January-February 2019, 4 (4-8) days for March-April 2019, and 5 (4-5) days for January-February 2020.

Investigators highlighted their analysis indicated no significant differences between the COVID-19 period and the pre-COVID-19 period in regard to mortality (1 patient [5.0%] vs 1 patient [3.6%], respectively; P=.81) and 30-day rehospitalization rates (4 patients [22.2%] vs 6 patients [21.4%], respectively; P=.90).

“While the pandemic continues to evolve, self-care during this difficult time is critical to our heart health, and our overall health,” said senior investigator Grant Reed, MD, MSc, director of the Cleveland Clinic’s STEMI program, in the aforementioned statement. “For those who feel overwhelmed by stress, it’s important to reach out to your healthcare provider. Exercise, meditation and connecting with family and friends, while maintaining physical distance and safety measures, can also help relieve anxiety.”

This study, “Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic,” was published in JAMA Network Open.