Long-term prognosis following hospitalization for acute myocarditis – a matched nationwide cohort study. (1st October 2021)

• Record Type: Journal Article
• Authors: Ghanizada, Muzhda; Kristensen, Søren L.; Bundgaard, Henning; Rossing, Kasper; Sigvardt, Flora; Madelaire, Christian; Gislason, Gunnar H.; Schou, Morten; Hansen, Morten L.; Gustafsson, Finn
• Is Part Of: Scandinavian cardiovascular journal. Volume 55:Number 5(2021)
• Page Start: 264
• Page End: 269
• Publication Date: 2021-10-01
• Subjects: Myocarditis -- prognosis -- heart failure -- mortality; Cardiovascular system -- Diseases -- Periodicals; 617.41
• DOI: 10.1080/14017431.2021.1900596
• Languages: English
• ISSNs: 1401-7431

Abstract

Abstract: Objective . The aim of this study was to examine the long-term risk of heart failure (HF) and all-cause mortality, in patients discharged alive following hospitalization for myocarditis. Background . Prognosis in patients with apparently uncomplicated myocarditis is in general perceived as good, but data on long-term outcomes are sparse. Methods. From nationwide Danish registries we included patients without prior cardiac disease, discharged alive with a first-time diagnosis of myocarditis 1996–2016. Patients were matched 1:10 by age- and sex, with controls from the general population. Risk of HF hospitalization and death in cases and controls was compared by use of adjusted Cox regression analyses. Results . We identified 1557 patients with a first-time diagnosis of myocarditis, 72% men, median age 39 years. Patients with myocarditis had more hypertension, diabetes, and cancer, and received more pharmacotherapy prior to hospitalization compared to matched controls. During a mean follow-up of 8.5 years, the event rate of HF hospitalization was 8.7 vs. 2.2 per 1000 patient-years (py) in cases and controls; HR 4.59 (95% CI; 3.58–5.88) and for all-cause mortality, event rate 21.9 vs 11.2 per 1000 py; HR 2.10 (95% CI; 1.82–2.43). Among 784 patients with no events or HF medication one year after diagnosis, risk of HF hospitalization (HR 2.15; 95% CI; 1.18–3.92), and all-cause mortality (HR 1.62; 95% CI; 1.21–2.16) remained elevated compared to matched controls. Conclusion . Myocarditis in younger patients without prior cardiac disease was associated with a long-term excess risk of HF hospitalization, and death, even in patients free of events and HF medication 1 year after discharge. Highlights: Myocarditis ranges from chest discomfort to severe heart failure. In most patients, left ventricular ejection fraction recovers but the long-term adverse cardiac risk is unknown. Patients with myocarditis and no prior cardiac disease were at higher risk of death and heart failure Routine follow-up may be warranted following an episode of acute myocarditis.