Takotsubo Syndrome More Likely in Older Women With Mental Health Disorders

Senior woman with pain on heart in living room, Mature female presses hand to chest has heart attack suffers from unbearable pain
In this study, researchers used the US National Inpatient Sample (NIS) public database to compile the discharge notes of 10.9 million women aged 60 years and older who were hospitalized with severe cardiac symptoms.

The association between mental health disorders (MHD) and Takotsubo syndrome (TS) or Takotsubo cardiomyopathy, or “broken heart syndrome,” has been identified among women aged 60 years and older with MHD complicated by transient cardiac symptoms, according to study findings published in The Journal of Women’s Health.

In this study conducted between 2007 and 2015, researchers used the US National Inpatient Sample (NIS) public database to compile the discharge notes of 10.9 million women aged 60 years and older who were hospitalized with severe cardiac symptoms. TS may mimic short-lasting but severe dysfunction of the left ventricle, with potential escalation to systolic heart failure and ventricular arrhythmias that increase the risk for recurrent cardiac-related traumas.

Although the pathophysiology of TS lacks awareness and is not fully understood, researchers noted that TS may be caused by emotional or physical stress, as well as acute neurologic diseases. Data are inconclusive as to whether MHD instigate or are a consequence of a TS diagnosis.

MHD were defined by conditions surrounding adjustment disorders, anxiety disorders, and mood disorders. The researchers assessed 10,884,613 nonelective hospital admissions to identify MHD in patients with either a primary (n=4749) or secondary (6702) diagnosis of TS, as well as when grouped together. International classification of diseases (ICD) codes and classification software (CCS) codes were used to diagnose TS and MHD, respectively. Two regression models showed the influence sociodemographic, hospital-level and behavioral/lifestyle factors had on the association between MHD and TS.

“Significant differences in sociodemographic, behavior/lifestyle factors, and chronic conditions were observed by MHD status,” the researchers noted. “Compared with patients without MHD, a greater proportion of patients with MHD reported White race and were younger, current smokers, obese, and had higher prevalence of substance use disorder and clinical conditions such dyslipidemia, dementia, chronic obstructive pulmonary disease, and cancer.”

Researchers concluded that MHD were associated with an increased risk for TS (odds ratio, 1.25; 95% CI, 1.18-1.32). The CI increased for patients with a secondary diagnosis of TS (95% CI, 1.30-1.50). Although the association between TS and MHD requires further investigation, the researchers noted the risk for TS was increased in patients with adjustment and mood disorders, such as generalized anxiety disorder, and decreased among those with a history of attempted suicide and self-harm injuries and those with personality disorders, including schizophrenia.

Limitations of this study included potential diagnostic errors from the use of ICD codes, and potential patient duplication in the NIS­­. In addition, there was a lack of accessible data on cardiac screenings, medication regimens, laboratory results when making a TS diagnosis, missed variables/covariates when determining outside influences potentially misrepresenting the association between MHD and TS, and missing clinical predictors of outcomes.

“The prevalence of TS in the United States increased by about fourfold from 2007 to 2015 among older women, with the prevalence higher among patients with diagnosis of MHD,” the researchers noted. “Overall, this study found a positive association between MHD and TS. This association, which was not homogeneous across the entire spectrum of MHD, was observed to increase with the number of MHD diagnosed. Further studies are needed to elucidate the underlying mechanisms linking MHD with TS.” 


Appiah D, Noamesi AT, Osaji J, Bolton C, Nwabuo CC, Ebong IA. The association of mental health disorders with takotsubo syndrome (broken heart syndrome) among older women. J Women’s Health. Published online March 3, 2022. doi:10.1089/jwh.2021.0557