Predictors of 90-day readmission and in-hospital mortality in takotsubo cardiomyopathy: An analysis of 28,079 index admissions

• Published in: Cardiovascular revascularization medicine 2019-11, Vol.20 (11), p.973-979
• Main Authors: Yerasi, Charan, Tripathi, Byomesh, Banga, Sandeep, McNown, Camila, Jonnalagadda, Anil K, Al-Qaisi, Saifuldeen, Miryala, Varun, Nafisi, Sina, Waksman, Ron, Ben-Dor, Itsik
• Format: Article
• Language: English
• Subjects: Cardiovascular; Mortality; Nationwide Readmissions Database; Predictors; Readmissions; Takotsubo cardiomyopathy
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2019.08.004

AbstractBackgroundTakotsubo 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. MethodsThe 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. ResultsA 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. ConclusionsPatients 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. SummaryThis 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.