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

JACC Heart Fail. 2016 Mar;4(3):197-205. doi: 10.1016/j.jchf.2015.09.013. Epub 2015 Dec 30.

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Fee-for-Service Plans / economics
  • Fee-for-Service Plans / statistics & numerical data*
  • Fee-for-Service Plans / trends
  • Female
  • Hospital Mortality
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medicare / economics
  • Medicare / statistics & numerical data*
  • Medicare / trends
  • Risk Factors
  • Sex Distribution
  • Takotsubo Cardiomyopathy / economics
  • Takotsubo Cardiomyopathy / mortality
  • Takotsubo Cardiomyopathy / therapy*
  • Treatment Outcome
  • United States