Abstract
An excessive catecholaminergic surge is felt to lead to Takotsubo cardiomyopathy (TC) and related arrhythmia. We sought to evaluate if this increased the risk of atrial fibrillation (AF) and related outcomes during hospitalization. We utilized the Nationwide Inpatient Sample to identify the hospitalizations due to TC and concurrent AF using appropriate ICD-9 and ICD-10 CM codes from 2009-2018. The study population was divided into patients with and without AF. Propensity score matching (PSM) was used to control and match possible confounders. The primary outcome was all-cause mortality. Secondary outcomes included acute heart failure (AHF), stroke, length of hospital stay (LOS), and cost of care (COC). Out of 289,641 hospitalizations with TC, 50,664 had concurrent AF. A total of 16,385 hospitalizations were included in each group after PSM. TC with concurrent AF was associated with higher in-hospital mortality (6.10% vs. 4.40%, aOR 1.44, CI 1.30-1.59, P<0.0001). AF in TC was also associated with increased risk of AHF (24.53% vs. 18.68%, aOR 1.48, CI 1.40-1.57, P<0.0001) and stroke (5.07% vs. 3.57%, aOR 1.45, CI 1.31-1.63, P<0.0001). Moreover, LOS (average 5 days vs. 4 days, P<0.001) and COC (average $12609 vs. $10775, P=0.002) were also higher in TC with AF. Finally, a rising trend of AF in TC was observed from 2009 to 2016, which got plateaued from 2016-2017 and decreased in 2018. Hospitalization for TC complicated by AF is associated with higher in-hospital mortality and acute heart failure. These data suggest that more aggressive AF control is merited in patients.
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