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

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.

Sex Differences in Incidence, Clinical Characteristics and Outcomes in Children and Young Adults Hospitalized for Clinically Suspected Myocarditis in the Last Ten Years—Data from the MYO-PL Nationwide Database

“…Public health insurance is obligatory for almost all Polish residents. More research results have already been published based on the NHF data regarding the incidence and management of certain diseases [ 9 , 10 ].…”

Personalized Management of Myocarditis and Inflammatory Cardiomyopathy in Clinical Practice

“…Patients with suspected myocarditis are mostly young (in a recent nationwide study, the median age was 32 and 46 years in males and females, respectively) and the majority are male (approximately 75%) regardless of the age group [1]. Seasonal changes in the incidence of suspected myocarditis have also been observed, with the highest rates of hos-pital admissions occurring from late autumn to early spring, which might reflect infectious and particularly viral causes [24].…”

“…However, myocarditis is not a rare disease. The incidence of first-time hospitalizations with suspected myocarditis was reported at approximately 60 per 100,000 people per year in a recent 10year observational study [1]. Moreover, current reports show that the incidence of myocarditis and inflammatory cardiomyopathy has been rising in recent years/decades [1,2].…”

“…Diagnosis of myocarditis should follow a systematic approach (with a common definition following strict criteria and with a final confirmation by endomyocardial biopsy (EMB)), while in most situations, it is still a clinician judgment-based diagnosis of exclusion. This was highlighted in a recent Polish nationwide study, which showed that performance of the recommended diagnostic tests (in particular, EMB and cardiac magnetic resonance (CMR)) was very low in clinical practice [1]. The complications of sub-optimally treated myocarditis may be serious, including reduced quality of life and ability to work, arrhythmias, dilated cardiomyopathy, death, or heart transplantation.…”

Sex and autoimmunity in acute myocarditis: time for a refresh

“…Decades of experimental studies document a protective effect of oestrogen and detrimental effect of testosterone in enteroviral myocarditis 3 . However, worse survival in women was also seen in epidemiological studies from the US and Poland 4,5 . The greater frequency of anti‐heart autoantibodies in women (59/154, 38%) suggested a possibly modifiable pathway.…”