Hospital readmission following takotsubo syndrome.

Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction with symptoms and electrocardiographic changes mimicking acute myocardial infarction (AMI). The objective of this study was to evaluate in-hospital death and hospital readmission in patients with TTS and to compare outcomes to patients with AMI. Patients diagnosed with TTS and AMI were identified using the United States Nationwide Readmission Database from 2010 to 2014. In-hospital outcomes for the index admission, and rates and causes of 30 day readmissions were compared between TTS patients and AMI patients without TTS. Sixty-one thousand, four hundred, and twelve patients with TTS and 3 470 011 patients with AMI without TTS were identified. Patients with TTS were younger, more often women (89% vs. 41%), and less likely to have cardiovascular risk factors than AMI patients. Mortality during the index admission was lower in TTS compared with AMI (2.3% vs. 10.2%, P < 0.0001). Cardiogenic shock occurred at the same frequency (5.7%) with TTS or AMI. Among TTS survivors, 7132 patients (11.9%) were readmitted within 30 days, and mortality associated with readmission was 3.5%. The most common reason for readmission after TTS was heart failure (HF; 10.6% of readmissions). Takotsubo syndrome is associated with substantial morbidity and mortality. Although outcomes are more favourable than AMI, approximately 2% of patients died in hospital and approximately 12% of survivors were readmitted within 30 days; HF was the most frequent indication for rehospitalization. Careful outpatient follow-up of TTS patients may be warranted to avoid readmissions.

Smilowitz NR ，Hausvater A ，Reynolds HR 《-》

In-hospital Takotsubo syndrome versus in-hospital acute myocardial infarction among patients admitted for non-cardiac diseases: a nationwide inpatient database study.

Isogai T ，Matsui H ，Tanaka H ，Fushimi K ，Yasunaga H ... -  《-》

Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction: An 8-Year National Perspective on Clinical Characteristics, Management, and Outcomes.

This study sought to evaluate the clinical characteristics and outcomes of Takotusbo cardiomyopathy cardiogenic shock (TC-CS) in comparison to those of acute myocardial infarction cardiogenic shock (AMI-CS) among patients hospitalized in the United States. We additionally sought to compare the incidence of multiorgan failure and use of supportive therapies as well as the trends over time, given the increasing awareness and diagnosis of TC. CS is a major complication of TC; however, there are limited data, especially as to how TC-CS compares to AMI-CS. The National Inpatient Sample Database was used to identify adults hospitalized with CS in the setting of TC and AMI from 2007 to 2014. We required patients admitted with TC to have undergone coronary angiography without intervention. Clinical characteristics and in-hospital outcomes in TC-CS patients were compared with those in AMI-CS patients. Multivariate regression and propensity matching were used to adjust for potential confounding factors. Between 2007 and 2014, there were 374,152 admissions for CS due to either TC or AMI, of which 4,614 patients (1.2%) had TC-CS. TC-CS admission patients were more likely to be younger, white females with fewer comorbidities. Rates of respiratory failure and mechanical ventilation were higher in TC-CS, but cardiac arrest and acute kidney injury were lower. There were no differences between cohorts in use of intra-aortic balloon pumps. TC-CS admissions had lower in-hospital mortality (15% vs. 37%, respectively) and hospital costs (U.S. dollars: $135,397 ± $127,617 vs. $154,827 ± $186,035, respectively) and were discharged home more often (45% vs. 36%, respectively) compared to AMI-CS admissions (all: p < 0.001). After adjustments for potential confounders, TC-CS was associated with lower in-hospital mortality (odds ratio [OR]: 0.35; 95% confidence interval [CI]: 0.32 to 0.38; p < 0.001). Similar findings were observed in the propensity-matched cohort (OR: 0.32; 95% CI: 0.25 to 0.39; p < 0.001). There are key differences between the clinical characteristics and multiorgan failure patterns in TC-CS compared to those in AMI-CS. In-hospital mortality (15%) is lower in TC-CS.

Vallabhajosyula S ，Dunlay SM ，Murphree DH Jr ，Barsness GW ，Sandhu GS ，Lerman A ，Prasad A ... -  《-》

Predictors of 90-Day Readmission and in-Hospital Mortality in Takotsubo Cardiomyopathy: An Analysis of 28,079 Index Admissions.

Takotsubo cardiomyopathy (TC) is diagnosed in 1% to 2% of patients presenting with suspected acute coronary syndromes. Readmission patterns after TC have been less studied. Thus, we sought to perform a study to evaluate the etiologies, trends, and predictors of 90-day readmission in TC. The Nationwide Readmissions Database (NRD), 2014, was used to select the study cohort. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code 429.83 was used to identify TC. Admissions within 90 days of index admission were considered early readmissions. Readmission etiologies were identified by an ICD-9-CM code. Hierarchical multivariate models were used to evaluate predictors of early readmission. A total of 28,079 patients were identified during the study period, of whom 24.3% (n = 6841) were readmitted within 90 days of discharge. In-hospital mortality during index admissions was 5.69%. The most common etiologies for readmission were cardiac (18.56%), respiratory (17.20%), and infections (13.12%). Among cardiac complications, acute heart failure was the most common etiology (7.48%). The highest number of readmissions happened on the first day after discharge (n = 125). On multivariate analysis, the age of 50-64 years, diabetes, heart failure, chronic pulmonary disease, peripheral vascular disease, anemia, and malignancy were shown to be significant predictors of readmission. Patients of female gender are less likely to be readmitted and have lower in-hospital mortality. Patients with TC are highly likely to be readmitted within the first month after discharge, most likely with secondary to cardiac or respiratory complications. These findings warrant close post-discharge transition to reduce morbidity and improve healthcare outcomes. This analysis from the Nationwide Readmission Database outlines a detailed analysis on etiologies, trends, and predictors of 90-day readmission for patients presenting with takotsubo cardiomyopathy.

Yerasi C ，Tripathi B ，Banga S ，McNown C ，Jonnalagadda AK ，Al-Qaisi S ，Miryala V ，Nafisi S ，Waksman R ，Ben-Dor I ... -  《-》

Prevalence, Causes, and Predictors of 30-Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013-2014 National Readmissions Database.

Prior studies have shown that survivors of acute myocardial infarction (AMI) complicated by cardiogenic shock are likely to have increased risk of readmissions in the early post-discharge period. However, the contemporary prevalence, reasons, and predictors of 30-day readmissions are not well known. Hospitalizations for a primary diagnosis of AMI complicated by cardiogenic shock, and discharged alive, were identified in the 2013 and 2014 Nationwide Readmissions Databases. Prevalence and reasons for 30-day unplanned readmissions were investigated. A hierarchical logistic regression model was used to identify independent predictors of 30-day readmissions. Among 1 116 933 patient hospitalizations with AMI, 39 807 (3.6%) had cardiogenic shock and were discharged alive. Their 30-day readmission rate was 18.6%, with a median time for readmission 10 days post discharge. Predictors of readmission included: non-ST-segment elevation myocardial infarction, female sex, low-income status, nonprivate insurance, chronic renal failure, long-term ventricular assist device or intra-aortic balloon placement, and tachyarrhythmia. The majority of readmissions were attributable to cardiac-related causes (52%); heart failure being the most frequent cardiac cause (39% of all cardiac causes). Noncardiac-related readmissions included infections (14.9%), bleeding (5.3%), and respiratory causes (4.9%). The median cost per readmission was $9473 US dollars ($5037-20 199). Among survivors of AMI complicated by cardiogenic shock who were discharged from hospital, almost 1 in 5 are readmitted at 30 days, mainly because of cardiac reasons such as heart failure and new AMI. The risk of readmission was associated with certain baseline patient/hospital characteristics.

Mahmoud AN ，Elgendy IY ，Mojadidi MK ，Wayangankar SA ，Bavry AA ，Anderson RD ，Jneid H ，Pepine CJ ... -  《Journal of the American Heart Association》