Increase in Stress Cardiomyopathy Incidence During the COVID-19 Pandemic

The incidence of stress cardiomyopathy has increased during the coronavirus disease 2019 (COVID-19) pandemic, according to the results of a cohort study published in Cardiology.

The increased psychologic, social, and economic uncertainty resulting from the COVID-19 pandemic may contribute to an increase in the incidence of stress cardiomyopathy.

In this retrospective analysis of medical records from the Cleveland Clinic health system in Ohio, the data of patients admitted for acute coronary syndrome were examined for the following time periods (all pre-pandemic control groups): March or April of 2018 (n=290), January or February of 2019 (n=309), March or April of 2019 (n=679), and January or February of 2020 (n=278).

The incidences of stress cardiomyopathy in these cohorts were compared with those in patients admitted for acute coronary syndrome during the start of the COVID-19 pandemic (March or April of 2020; n=258). All patients in the COVID-19 cohort tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as assessed by reverse transcription–polymerase chain reaction

In the pre-pandemic subgroups, the incidence of stress cardiomyopathy ranged from 1.5% to 1.8%. The incidence of stress cardiomyopathy was higher in the COVID-19 cohort (7.8%; P <.001). Compared with the combined pre-pandemic periods, the rate of stress cardiomyopathy in the COVID-19 period was 4.58 times higher (95% CI, 4.11-5.11; P <.001).

The median length of hospital stay was also higher in the COVID-19 group (8 days) compared with any of the pre-pandemic subgroups (March-April 2018: 4 days; January-February 2019: 5 days; March-April 2019: 4 days; January-February 2020: 5 days; P =.006).

There were no significant difference in the rates of mortality or 30-day rehospitalization between any of the subgroups.

The investigators noted that the results of the study should be interpreted with caution when considering patients in other states or countries. Additionally, patients with acute coronary syndrome may have chosen to avoid visiting a hospital during a pandemic, which may have resulted in sampling bias.

“This cohort study found a significant increase in the incidence of stress cardiomyopathy during the COVID-19 pandemic,” the study authors concluded. “In addition, no patients with stress cardiomyopathy were found to have COVID-19, suggesting an indirect, psychologic, social, and economic pandemic-related stress mechanism behind the disease process.”

Reference

Jabri A, Kalra A, Kumar A, et al. Incidence of stress cardiomyopathy during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020;3(7):e2014780. doi:10.1001/jamanetworkopen.2020.14780