Trends in Short- and Long-Term Outcomes for Takotsubo Cardiomyopathy Among Medicare Fee-for-Service Beneficiaries, 2007 to 2012

Abstract

Objectives: The aim of this study was to assess trends in hospitalizations and outcomes for Takotsubo cardiomyopathy (TTC).

Background: There is a paucity of nationally representative data on trends in short- and long-term outcomes for patients with TTC.

Methods: The authors examined hospitalization rates; in-hospital, 30-day, and 1-year mortality; and all-cause 30-day readmission for Medicare fee-for-service beneficiaries with principal and secondary diagnoses of TTC from 2007 to 2012.

Results: Hospitalizations for principal or secondary diagnosis of TTC increased from 5.7 per 100,000 person-years in 2007 to 17.4 in 2012 (p for trend < 0.001). Patients were predominantly women and of white race. For principal TTC, in-hospital, 30-day, and 1-year mortality was 1.3% (95% confidence interval [CI]: 1.1% to 1.6%), 2.5% (95% CI: 2.2% to 2.8%), and 6.9% (95% CI: 6.4% to 7.5%), and the 30-day readmission rate was 11.6% (95% CI: 10.9% to 12.3%). For secondary TTC, in-hospital, 30-day, and 1-year mortality was 3% (95% CI: 2.7% to 3.3%), 4.7% (95% CI: 4.4% to 5.1%), and 11.4% (95% CI: 10.8% to 11.9%), and the 30-day readmission rate was 15.8% (95% CI: 15.1% to 16.4%). Over time, there was no change in mortality or readmission rate for both cohorts. Patients ≥85 years of age had higher in-hospital, 30-day, and 1-year mortality and 30-day readmission rates. Among patients with principal TTC, male and nonwhite patients had higher 1-year mortality than their counterparts, whereas in those with secondary TTC, mortality was worse at all 3 time points. Nonwhite patients had higher 30-day readmission rates for both cohorts.

Conclusions: Hospitalization rates for TTC are increasing, but short- and long-term outcomes have not changed. At 1 year, 14 in 15 patients with principal TTC and 8 in 9 with secondary TTC are alive. Older, male, and nonwhite patients have worse outcomes.

Keywords: apical ballooning syndrome; mortality; readmission; stress cardiomyopathy.

Figure 1

The figure contrasts the outcomes for the principal TTC (Takotsubo cardiomyopathy) cohort with a comparable group of white, female Medicare fee-for-service beneficiaries with acute myocardial infarction. On the x-axis is percentage mortality. On the y-axis are 2 stacked bars, 1 for each condition, showing in-hospital, discharge to 30-day and 31–365 day mortality. Data for Takotsubo cardiomyopathy are for 2011–2012 and data for acute myocardial infarction are for 2010–2011.

Figure 2

Risk-adjusted trend in 30-day mortality, 1-year mortality, and 30-day readmission for principal TTC cohort. The figure is divided vertically into 3 panels (1-year mortality, 30-day mortality, and 30-day readmission). On the vertical axis are the 3 time periods (2007–2008, 2009–2010, 2011–2012, with 2007–2008 serving as reference). Within each panel, the strength of effect is shown along the horizontal axis with the vertical dotted line demarcating an odds ratio (OR) of 1 (i.e., no difference in the risk adjusted outcome compared with 2007–2008); estimates to the right (i.e., >1) are associated with a greater likelihood of the outcome, while those to the left (i.e., <1) indicate a reduced likelihood of the outcome. Each dot represents the point estimate of the effect of that time period in the model, while the line shows the 95% confidence interval (CI).