Clinical Practice Variations in the Management of Stress-Induced Cardiomyopathy: A Canadian Perspective.

Abstract

Despite increased recognition of stress-induced cardiomyopathy (SIC), there are no randomized controlled trials or established guidelines to direct therapeutic strategies and little is known about the local experience in Canada. The objective of this study was to better understand the clinical practice variations in the management of SIC across Canada. By using an online platform, a series of questions were distributed to practicing cardiologists between October and November 2018. In total, 172 cardiologists completed the survey. Although many cardiologists have managed patients with SIC, more than two-thirds do not adhere to any guidelines or references. Of those who do, the top referenced resources included expert consensus statements from the American College of Cardiology, the European Society of Cardiology, general heart failure guidelines, and UpToDate. Regarding investigations, most participants routinely order TTEs and coronary angiograms, and a minority would order pheochromocytoma workup. Common medications prescribed for hemodynamically stable patients include β-blockers, angiotensin-converting enzyme inhibitors, antiplatelet agents, and anticoagulation. Some 3% of participants reported not prescribing any cardiac medications. Most respondents follow up with patients with SIC within a 3-month period. The risk factors most believed to be associated with SIC included female gender, anxiety, older age, ethnicity, and diabetes. No participants believed that male gender was a risk factor. Many participants believed there needs to be improvements made, such as a Canadian guideline, a Canadian registry, or dedicated workshops at the national cardiology conference. This study demonstrates ongoing variability in the clinical management of SIC across Canada and illustrates a potential area for further research.