Beta-Blockers and Long-Term Mortality in Takotsubo Syndrome: Results of the Multicenter GEIST Registry

BACKGROUND Beta-blockers are considered a reasonable therapy for patients with Takotsubo syndrome (TTS), commonly used despite the absence of consistent evidence about its prognosis impact. OBJECTIVES This study aimed to assess the impact of beta-blocker therapy on long-term mortality and TTS recurrence. METHODS The authors analyzed 2,853 patients discharged with a confirmed TTS diagnosis, enrolled in the international multicenter GEIST (The GErman Italian Spanish Takotsubo Registry). They performed a propensity score matching analysis to draw up 2 groups of 697 patients paired according to whether or not they received medical therapy with beta-blockers at hospital discharge. The prognostic value of beta-blockers at discharge to predict mortality and TTS recurrence during follow-up was analyzed using Cox regression. RESULTS During a mean follow-up of 2.6 years, 485 patients (17.0%) died and 97 (3.4%) have had TTS recurrence. Patients treated with beta-blockers at discharge (n 1/4 2,125) (74.5%) had a lower mortality rate (6.0 vs 8.1 per 100 patients/year). After propensity score matching, the authors found that mortality during follow-up was lower in the beta-blocker group (HR: 0.71; 95% CI: 0.55-0.90). Differences in mortality were especially at the expense of mortality in the first year. No differences were found by subgroups. Moreover, beta-blocker therapy was not associated with lower TTS recurrence during the follow-up (HR: 0.74; 95% CI: 0.61-1.89). No association between the use of beta-blockers at discharge and left ventricle ejection fraction recovery has also been observed. CONCLUSIONS Beta-blocker therapy in patients with TTS is associated with lower follow-up mortality, but not with lower TTS recurrence. (The GErman Italian Spanish Takotsubo Registry [GEIST]; NCT04361994) (JACC Heart Fail. 2025;13:815-825) (c) 2025 by the American College of Cardiology Foundation.