New Insights Into Mortality in Takotsubo Syndrome

The multicenter SSU-AHF trial randomized 193 lower-risk patients, mean age of 64.8 years, presenting at the emergency department (ED) with AHF symptoms to an SSU for brief (< 24 h) observation or hospital admission.
From electronic health records and telephone interviews at 30 days and 90 days, researchers collected data to assess vital status, all-cause rehospitalizations, ED revisits, and quality of life.
Owing to challenges posed by COVID-19, the primary outcome was changed from days alive and out of hospital (DAOOH) to quality of life, as measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) short form, on which a change of five points is deemed clinically important, and DAOOH became a secondary outcome.
The composite outcome of all-cause mortality and rehospitalization included time from randomization to either all-cause death or rehospitalization at 30 days and 90 days.

At 30 days, KCCQ-12 scores improved in both arms to well above five points, but there was no significant group difference (mean score, 51.3 in 65 SSU patients vs 45.8 in 68 hospitalized patients for a mean difference of 5.6 points; P = .19).
Participants in the SSU arm had a significant 1.6 more DAOOH than the hospitalized group at 30 days (median, 26.9 days vs 25.4 days; P = .02), which is notable given 41.9% of SSU participants required hospitalization and had a longer combined ED and hospital length of stay, said the authors.
There were no differences between arms for 30-day all-cause death or rehospitalization (P = .94); by 90 days, there was a total of seven deaths (three in the SSU arm and four in the hospitalization arm).
Adverse events were relatively rare and didn't differ significantly between groups (16.1% in SSU vs 16.0% in hospitalization arms).

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