2373Effect of ethninicty on in-hospital outcomes of takotsubo cardiomyopathy, data from the national inpatient sample database

Abstract

Abstract Background The effect of ethnicity on in-hospital outcomes of takotsubo cardiomyopathy (TC) is unknown. Purpose To investigate ethnic variations in hospital outcomes of TC in a large nationwide sample. Methods The National Inpatient Sample (NIS) database was searched from 2004 to 2014 for the ICD-9-CM code 429.83 to obtain weighted estimates of TC hospitalizations. Based on self-reported ethnicity, African-Americans (AA) and Hispanics were compared to Caucasians for differences in baseline characteristics and in-hospital outcomes. Multivariate regression models were used to adjust for potential confounders. Results Of 103891 hospital admissions identified, 89624 (86.3%) were Caucasians, 8026 (7.7%) were AA and 6241 (6%) were Hispanics. Caucasians were older with more females as compared to AA and Hispanics (67.5 [0.13] vs 61.8 [0.45] vs 63.2 [0.52] years, p<0.0001) and (78135 [87.2%] vs 6672 [83.1%] vs 5196 [83.3%], p<0.0001) respectively. Patients' demographics and baseline characteristics are shown in table 1. In unadjusted analysis (Figure 1), compared to Caucasians, AA had more cardiac arrests (304 [3.79%] vs 2569 [2.87%], p=0.038), invasive mechanical ventilation (1671 [20.8%] vs 15897 [17.7%], p<0.002) and tracheostomies (242 [3%] vs 1600 [1.8%], p=0.0009). When comparing Hispanics to Caucasians, Hispanics had higher mortality (426 [6.83%] vs 4573 [5.1] deaths, p=0.007). In adjusted analysis for baseline characteristics differences and hospital location/teaching status, AA had less cardiogenic shocks (OR=0.71 [95% CI 0.56–0.91], p=0.006) and intraaortic balloon pump support (OR= 0.6 [95% CI 0.39- 0.93], p=0.023) but required longer hospitalization (1.64 vs 1.56 log transformed-days, p=0.0001) as compared to Caucasians. Hispanics still had higher mortality than Caucasians (OR =1.27 [95% CI 1.01–1.61], p=0.04). Table 1. Patients' demographics and baseline characteristics Parameter Caucasians African Americans Hispanics Total p-value Age, years 67.46 (0.13) 61.77 (0.45) 63.15 (0.52) 66.76 (0.12) <0.0001 Females 78,135 (87.18%) 6,672 (83.13%) 5,196 (83.25%) 90,003 (86.63%) <0.0001 Congestive heart failure 20,693 (23.09%) 2,066 (25.73%) 1,395 (22.36%) 24,155 (23.25%) 0.055 Chronic lung disease 26,815 (29.92%) 1,971 (24.54%) 1,200 (19.22%) 29,986 (28.86%) <0.0001 Diabetes mellitus 15,295 (17.07%) 2,071 (25.79%) 1,711 (27.41%) 19,077 (18.36%) <0.0001 Chronic kidney disease 9,065 (10.11%) 1,315 (16.37%) 795 (12.74%) 11,174 (10.76%) <0.0001 Smoking 29,535 (32.95%) 2,660 (33.13%) 1,303 (20.87%) 33,498 (32.24%) <0.0001 Figure 1. In-Hospital Outcomes Conclusion There is ethnic variation in hospital outcomes of takotsubo cardiomyopathy, some of which may be related to differences in patients' demographics and baseline characteristics. Acknowledgement/Funding Medstar Georgetown University Hospital/ Washington Hospital Center graduate medical education department funded the purchase of the database