Thirty-Day Readmission Rates after Takotsubo Syndrome with or without Malignancy: A Nationwide Readmissions Database Analysis.

Sun-Joo Jang,S Chiu Wong,Robert M Minutello,Jim W Cheung,David L Narotsky,Ilhwan Yeo,S Andrew Mccullough,Udhay Krishnan,Geoffrey Bergman,Dmitriy N Feldman,Harsimran S Singh,Chanel Jonas,Parag Goyal,Luke K Kim

doi:10.3390/jcm10163701

Abstract

The association between malignancy and readmission after Takotsubo syndrome (TTS) hospitalization has not been fully described. We sought to examine the rates, cause, and cost of 30-day readmissions of TTS, with or without malignancy, by utilizing Nationwide Readmissions Databases from 2010 to 2014. We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy tended to be older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio (OR), 1.35; 95% confidence interval (CI), 1.18–1.56). Non-cardiac causes were the most common causes of readmission for TTS patients with malignancy versus without malignancy (75.5% vs. 68.1%, p < 0.001). The 30-day readmission rate due to recurrent TTS was very low in both groups (0.4% and 0.5%; p = 0.47). The total costs were higher by 25% (p < 0.001) in TTS patients with vs. without malignancy. In summary, among patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission and increased costs. These findings highlight the importance of optimized management for TTS patients with malignancy.

Highlights

The Takotsubo syndrome (TTS), known as stress-induced cardiomyopathy, can mimic acute coronary syndrome (ACS) and is an increasingly recognized cause of heart failure [1,2]
Using the NRD between 2010 and 2014 to delineate 30-day clinical outcomes in patients hospitalized for TTS with or without malignancy, we identified several key findings
Malignancy was independently associated with an increase in 30-day total charges and costs in patients hospitalized for TTS

Summary

Introduction

The Takotsubo syndrome (TTS), known as stress-induced cardiomyopathy, can mimic acute coronary syndrome (ACS) and is an increasingly recognized cause of heart failure [1,2]. The association between malignancy/chemotherapy and TTS has been reported in multiple studies [4,5,6]. Cancer patients who undergo systemic chemotherapy and/or radiation therapy often develop endothelial dysfunction in their epicardial and microvascular coronary vasculatures, which may play an important role in the high frequency of TTS observed in this cohort. A recent study demonstrated a high prevalence of malignancy among TTS patients with an increased long-term mortality in TTS patients with concomitant malignancy [4,5]. TTS has been shown to be associated with frequent (12%) 30-day readmission, the clinical impact of readmission on TTS patients with malignancy and its associated economic burden on the US healthcare system is less evident [6,7].

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Conclusion