Trends in hospitalization for takotsubo cardiomyopathy in the United States

Abstract

Background Takotsubo (or stress-induced) cardiomyopathy is characterized by transient left ventricular systolic dysfunction. Recent trends in patient volume, characteristics and outcomes in the United States are unknown. Methods Using 2007–2012 National Inpatient Sample data, we identified 22,005 adults (≥18 years) with a primary and 31,942 adults with a secondary discharge diagnosis of takotsubo cardiomyopathy (ICD-9 code 429.83) who underwent diagnostic coronary angiography. Results During 2007–2012, the incidence of takotsubo cardiomyopathy increased over 3-fold: 52/million discharges in 2007 to 178/million in 2012 (P < 0.001). We found a temporal increase in the prevalence of cardiac arrest, cardiogenic shock, cardiovascular risk factors (diabetes, hypertension) and psychiatric disorders (P trend<0.0001 for all). In-hospital mortality was 1.1% and remained unchanged over this period (P=0.22). Compared to the primary diagnosis group, mortality in the secondary diagnosis group was higher (1.1% vs. 3.2%), and was associated with higher incidence of cardiogenic shock, cardiac arrest and respiratory failure. Men represent 8% of patients in the primary diagnosis group and 12% in the secondary group. In both groups men had a higher incidence of shock, cardiac arrest and respiratory failure. While their mortality was higher than women in the primary group (3.0% vs. 0.9%; adjusted odds ratio [OR] 3.85; 1.74 – 8.51), it was comparable in the secondary group (4.8% vs. 3.0%). Conclusions We found a marked increase in the hospitalization for takotsubo cardiomyopathy in the U.S. in recent years, suggesting higher incidence than prior reports. Although outcomes have remained favorable, there is an increasing burden of cardiovascular and psychiatric disorders in this population with growing cost of care. Risk of mortality is higher in men and in patients with underlying critical illness. The excess mortality in these groups appears to be mediated by greater severity of disease.

Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome

“…Furthermore, clinical characteristics (age, sex, ballooning pattern, presence of bystander coronary artery disease) of our TT populations are comparable to those of larger trials [7]. Our findings also suggest an increase (12/year in the retrospective phase versus 15.8/year in the prospective phase) in the diagnosis of TT as previously described [1,3].…”

“…Takotsubo syndrome (TT) is an increasingly diagnosed condition [1][2][3] and our understanding of its clinical profile has evolved. Straying away from the initial description [4,5] of ST elevation following an acute psychological stress, different electrocardiographic (ECG) presentations and other triggers, if any, are now more commonly reported [6].…”

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

“…It is possible that the increasing incidence of TTC could reflect a greater diagnosis and awareness, as highlighted in the discussion previously, but alternately could represent a false‐positive diagnosis. However, our data are consistent with national trends of both primary and secondary diagnosis of TTC from other groups, making a false‐positive diagnosis less likely 41. Our data sources did not allow us to capture processes of care—especially intravenous fluid therapy, vasopressor and inotrope use, and extent of positive pressure used in mechanical ventilation—all of which could potentially influence the development or worsening of TTC.…”

Probable protective role of diabetes mellitus in takotsubo cardiomyopathy: a review

“…71.7 ± 10.4 (94.6) 13.8 Dias et al [14] 206 67.8 (87) 19.0 Auzal et al [15] 90 71.9 ± 12.7 (97) 9.0 Khera et al [16] 22,005 65.7 (92.0) 18.0^, 2.6°E itel et al [17] 256 69 ± 12 (89) 19.0 Núñez-Gil et al [18] 100 68 (89) 18.0 Núñez-Gil et al [19] 202 70 ± 12.5 (90.1) 15.3 Templin et al [20] 1750…”

“…In another study utilizing the NIS Database data 2007 to 2012, Khera et al [16] identified 22,005 patients who were discharged with a primary diagnosis of TC in the US. The number of hospitalizations was seen to have increased nearly 3-fold, from 1,642 cases in 2007 to 5,480 cases in 2012.…”