Occurrence, Trends, Management and Outcomes of Patients Hospitalized with Clinically Suspected Myocarditis-Ten-Year Perspectives from the MYO-PL Nationwide Database

Krzysztof Ozierański, Agata Tymińska, Marcin Kruk, Beata Koń, Aleksandra Skwarek, Grzegorz Opolski, Marcin Grabowski, Krzysztof Ozierański, Agata Tymińska, Marcin Kruk, Beata Koń, Aleksandra Skwarek, Grzegorz Opolski, Marcin Grabowski

Abstract

The epidemiology of myocarditis is unknown and based mainly on small single-centre studies. The study aimed to evaluate the current incidence, clinical characteristics, management and outcomes of patients hospitalized due to myocarditis in a general population. The study was registered in ClinicalTrials.gov (NCT04827706). The nationwide MYO-PL (the occurrence, trends, management and outcomes of patients with myocarditis in Poland) database (years 2009-2020) was created to identify hospitalization records with a primary diagnosis of myocarditis according to the International Classification of Diseases and Related Health Problems, 10th Revision (ICD 10), derived from the database of the national healthcare insurer. We identified 19,978 patients who were hospitalized with suspected myocarditis for the first time, of whom 74% were male. The standardized incidence rate of myocarditis ranged from 1.15 to 14 per 100,000 people depending on the age group and was the highest in patients aged 16-20 years. The overall incidence increased with time. The performance of the recommended diagnostic tests (in particular, endomyocardial biopsy) was low. Relative five-year survival ranged from 0.99 to 0.56-worse in younger females and older males. During a five-year follow-up, 6% of patients (3.7% and 6.9% in females and males, respectively) were re-hospitalized for myocarditis. Surprisingly, females more frequently required hospitalization due to heart failure/cardiomyopathy (10.5%) and atrial fibrillation (5%) than compared to males (7.3% and 2.2%, respectively) in the five-year follow up. In the last ten years, the incidence of suspected myocarditis increased, particularly in males. Survival rates for patients with myocarditis were worse than in the general population. Management of myocarditis requires significant improvement.

Keywords: cardiomyopathy; children; endomyocardial biopsy; epidemiology; heart failure; mortality.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Age and gender distribution of all patients hospitalized for myocarditis in Poland in years 2011–2019. Red—females; blue—males.
Figure 2
Figure 2
Age-standardized hospitalization rates for myocarditis of males and females by the number of residents in Poland in the years 2011–2019.
Figure 3
Figure 3
Observed (a,b) and relative (c,d) ten-year survival rates of patients hospitalized for myocarditis in relation to sex and age.

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