THE PROGNOSTIC IMPACT OF MENTAL ILLNESS AMONG HOSPITALIZED PATIENTS WITH TAKOTSUBO CARDIOMYOPATHY IN TEXAS, 2007-2014

Abstract

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pre-existing mental illness is strongly associated with Takotsubo Cardiomyopathy (TC). However, although mental illness has been associated with reduced life expectancy, in part due to cardiovascular disease, and with increased mortality among hospitalized patients, its prognostic impact among patients with TC is unknown. We examined the population-level association of mental illness with short-term mortality among hospitalizations with TC. METHODS: We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥18 years with a principal diagnosis of TC (ICD-9 code 429.83) during 2007-2014. Mental illness was defined by the taxonomy of the Healthcare Cost and Utilization Project’s Clinical Classification Software Category 5. Sociodemographics, clinical characteristics, and mortality data were collected. Chi-square and Mann-Whitney testing was utilized for group comparisons. Multivariate logistic regression modeling was used to examine the association of mental illness with short-term mortality (defined as in-hospital death or discharge to hospice). Model discrimination and calibration were assessed using the area under the receiving operating characteristic (AUC) and Hosmer-Lemeshow test (HLT), respectively. RESULTS: There were 1,808 hospitalizations with TC (53.2% aged ≥65 years; 92.1% female; 29.1% non-white minority). Mental illness was reported in 781 (43.2%) hospitalizations. As compared to those without mental illness, hospitalizations with mental illness were younger (aged ≥65 years: 50.3% vs. 55.3%; p=0.019) and sicker (mean Deyo comorbidity index 1.4 vs. 1.2 [p=0.0003]; mean number of organ failures 0.54 vs. 0.41; p<0.0001). There was no difference between the groups in rates of left heart catheterization (90.3% vs. 91.1%; p=0.5266]), percutaneous coronary interventions (1.2% vs. 1.2%; p=0.8274) or of ICU admission (61.6% vs. 60.8%; p=0.7240), respectively. Crude short-term mortality among hospitalizations with and without mental illness was 3.1% vs. 1.6%, respectively (p=0.0301). On adjusted analyses, mental illness was associated with increased odds of short-term mortality (adjusted odds ratio 2.80 [95% CI 1.24-6.30]; p=0.0129). Model’s AUC was 0.94 (95% CI 0.93-0.95), with HLT p=0.924. CONCLUSIONS: Mental illness was prevalent among hospitalized patients with TC, with those affected being younger, but with greater burden of chronic illness and higher illness severity. Mental illness nearly tripled the odds of death among affected patients, even following adjustment for confounders. CLINICAL IMPLICATIONS: Our findings can inform physicians’ decision-making and preventive and care efforts. Further studies are needed to elucidate the mechanisms underlying the adverse prognostic impact of mental illness in TC. DISCLOSURES: No relevant relationships by Lavi Oud, source=Web Response No relevant relationships by Joshua Ronen, source=Web Response