Abstract
Background: Myocarditis is a life-threatening condition with an increasing incidence in the past two decades. Little is known about the frequency of specific causes of death following myocarditis. This study aimed to identify the different causes of death after myocarditis diagnosis and determine factors associated with mortality. Methods: We conducted a retrospective population-wide observational study in New South Wales (NSW), Australia from July 2004 to September 2021. Data were attained from the NSW Admitted Patient Data Collection database and death was tracked from the death registry to 31 March 2022. Cause of death was ascertained from manual reviews of all death certificates and adjudicated independently by three reviewers. Results: Among 4071 unique index admissions for myocarditis (median age: 42 years; 66% male), cumulative all-cause mortality was 4.5% in-hospital, 8.2% at 1 year, 13.3% at 5 years and 15.5% by the end of follow up (median 5.3 years). Within 30 days of admission, the leading cause of death was cardiovascular (66%), including myocarditis (36%) and heart failure (12%). Non cardiovascular causes accounted for 32% of deaths and included infection (17%) and malignancy (6%). Beyond 30 days, cardiovascular deaths declined to 34% (only 3% due to myocarditis). Higher mortality risk was associated with older age, higher Charlson comorbidity index, and myocarditis complicated by intensive care unit admission, heart failure, stroke, or arrhythmia. Conclusions: Patients admitted with myocarditis face significant mortality risks. The highest mortality occurs within the first 30 days, predominantly due to cardiovascular causes, although after 30 days the predominant cause of death shifts to non-cardiovascular causes.