Etiologies, predictors, and economic impact of readmission within 1 month among patients with takotsubo cardiomyopathy

Clin Cardiol. 2018 Jul;41(7):916-923. doi: 10.1002/clc.22974. Epub 2018 Jul 20.

Abstract

Background: Limited data exist on readmission among patients with takotsubo cardiomyopathy (TC), a commonly reversible cause of heart failure.

Hypothesis: We sought to identify etiologies and predictors for readmission among TC patients.

Methods: We queried the National Readmissions Database for 2013-2014 to identify patients with primary admission for TC using ICD-9-CM code 429.83. Patients readmitted to hospital within 1 month after discharge were further evaluated to identify etiologies, predictors, and resultant economic burden of readmission. Additionally, we analyzed readmission for TC at 6 months.

Results: We studied 5997 patients admitted with TC, of whom 1.2% experienced in-hospital mortality. Median age was 67 years, with 91.5% being female. Among survivors, 10.3% were readmitted within 1 month; 25% of the initial 1-month readmissions occurred within 4 days, 50% within 10 days, and 75% within 20 days from discharge. The most common etiologies for readmission were cardiac (26%), respiratory (16%), and gastrointestinal (11%) causes. Heart failure was the most common cardiac etiology. Significant predictors of increased 1-month readmission included systemic thromboembolic events, length of stay ≥3 days, and underlying psychoses. Obesity and private insurance predicted lower 1-month readmission. The annual national cost impact for index admission and 1-month readmissions was ≈$112 million. Recurrent TC was seen among 1.9% of patients readmitted within 6 months.

Conclusions: Though the overall rate of 1-month readmission following TC is low, associated economic burden from readmission is still significant. Patients are readmitted mostly for noncardiac causes. Readmission for another episode of TC within 6 months was uncommon.

Keywords: Etiologies; Predictors; Readmission; Takotsubo; Thromboembolism.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Databases, Factual
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Heart Failure / epidemiology*
  • Heart Failure / etiology
  • Hospital Mortality / trends
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission / trends*
  • Retrospective Studies
  • Risk Assessment*
  • Risk Factors
  • Survival Rate / trends
  • Takotsubo Cardiomyopathy / complications*
  • Takotsubo Cardiomyopathy / epidemiology
  • Time Factors
  • United States / epidemiology