In-Hospital Mortality Among Patients With Takotsubo Cardiomyopathy: A Study of the National Inpatient Sample 2008 to 2009
What are the in-hospital mortality and complication rates for patients diagnosed with takotsubo cardiomyopathy?
This was a retrospective analysis of patients enrolled into the National Inpatient Database from 2008-09 with an ICD-9 diagnosis of takotsubo cardiomyopathy. The primary outcome of interest was in-hospital mortality. Secondary outcomes included in-hospital complications (e.g., respiratory failure, ventricular fibrillation arrest, cardiogenic shock) and length of stay.
There were 24,701 patients with takotsubo cardiomyopathy. Critical illnesses were present in 28% (n = 6,892) of patients, including acute renal failure (10.5%), sepsis (7.1%), and stroke (2.7%). In-hospital mortality was 4.2% (n = 1,027). Mortality was higher in men (odds ratio [OR], 2.4; 95% confidence interval [CI], 2.1-2.8) with a trend toward higher mortality in patients ≥65 years of age (OR, 1.2; 95% CI, 0.96-1.5). Underlying concomitant critical illnesses (e.g., renal failure, stroke, sepsis) were present in 81% of patients who died with takotsubo cardiomyopathy. Patients with concomitant critical illnesses had a mortality of 12.1% compared with 1.1% for those without a concomitant critical illness. Complications developed in 35% of patients with takotsubo cardiomyopathy including cardiogenic shock (4.7%), acute heart failure (41%), cardiac arrest (2.8%), and respiratory failure (6.7%). Men with takotsubo cardiomyopathy were more likely to suffer cardiogenic shock (OR, 1.27; 95% CI, 1.07-1.51) and cardiac arrest (OR, 1.6; 95% CI, 1.3-2.0). The mortality rate in patients developing complications was 7.1%. Predictors of mortality on multivariable analysis included male sex (OR, 2.1; 95% CI, 1.7-2.5), presence of a critical care illness (OR, 1.2; 95% CI, 1.1-1.3), and Charlson comorbidity index (OR, 10.8; 95% CI, 9.1-13).
The authors concluded that mortality in takotsubo cardiomyopathy is highest in those with underlying critical illness and complications.
This is a very large analysis of takotsubo cardiomyopathy that demonstrates large differences in outcome based on a patient’s clinical course. It is not surprising that patients with concomitant critical care illnesses have higher mortality given their illness and complication burdens. In this setting, takotsubo cardiomyopathy may or may not be the primary cause of death. However, this analysis helps temper the belief that takotsubo cardiomyopathy is a benign condition. While congestive heart failure may or may not be the primary cause of death, takotsubo patients with complications have a high risk for mortality. In converse, the study assists in teasing out the lower-risk takotsubo cardiomyopathy patient: women and those without a complicated hospital course.
Keywords: Stroke, Hospital Mortality, Takotsubo Cardiomyopathy, Sepsis, Ventricular Fibrillation, Acute Kidney Injury, Respiratory Insufficiency, Heart Arrest, Critical Care, Length of Stay, Heart Diseases, Shock, Cardiogenic, Cause of Death, Renal Insufficiency, Heart Failure, Critical Illness, Confidence Intervals, Databases, Factual, Ventricular Dysfunction, Left
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