Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample
Abstract Aims Takotsubo cardiomyopathy (TC) is characterized by transient ventricular impairment, often preceded by emotional or physical stress. Racial differences affect the outcomes of several cardiovascular conditions; however, the effect of race on TC remains unknown. This investigation aims to...
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Wiley
2020-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12664 |
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| author | Raja Zaghlol Amit K. Dey Sameer Desale Ana Barac |
| author_facet | Raja Zaghlol Amit K. Dey Sameer Desale Ana Barac |
| author_sort | Raja Zaghlol |
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| description | Abstract Aims Takotsubo cardiomyopathy (TC) is characterized by transient ventricular impairment, often preceded by emotional or physical stress. Racial differences affect the outcomes of several cardiovascular conditions; however, the effect of race on TC remains unknown. This investigation aims to assess the effect of race on in‐hospital outcomes of TC in a large national sample. Methods and results We conducted a US‐wide analysis of TC hospitalizations from 2006 to 2014 by querying the National Inpatient Sample database for the International Classification of Diseases‐ninth Revision TC code, characteristics, and inpatient outcomes. Patients with a primary diagnosis of acute coronary syndrome were excluded to reduce selection bias. Caucasians were compared with African Americans (AA) for differences in baseline characteristics and in‐hospital outcomes. Multivariate regression models were created to adjust for potential confounders. Of 97 650 TC patients, 83 807 (86.9%) were women, 89 624 (91.8%) identified as Caucasians, and 8026 (8.2%) as AA. The annual number of TC hospitalizations increased significantly from 2006 to 2014 in both races (from 335 to 21 265 annual cases, P < 0.001). In‐hospital mortality initially increased (1–2% in 2006 to 5–6% in 2009, P < 0.001) and subsequently remained relatively stable around 5–7% with no significant difference between races. In unadjusted analysis, AA had more cardiac arrests [304 (3.8%) vs. 2569 (2.9%), P = 0.04], invasive mechanical ventilation [1671 (20.8%) vs. 15 897 (17.7%), P = 0.002], tracheostomies [242 (3%) vs. 1600 (1.8%), P = 0.001], acute kidney injuries [1765 (22%) vs. 14 608 (16.3%), P < 0.0001], and longer hospital stays [4.5 (3.2–4.8) vs. 3.8 (3.7–3.9) days, P < 0.0001] compared with Caucasians. After the adjustment for differences in age, gender, comorbidities (using the enhanced Charlson comorbidity index), hospital location/teaching status, and socio‐economic factors, all differences were significantly attenuated or eliminated. Additionally, the adjusted risk was lower in AA compared with Caucasians, for cardiogenic shock [odds ratio (OR) 0.61 (0.47–0.78), P < 0.0001], mechanical ventilation [OR 0.8 (0.70–0.92), P = 0.002] and intraaortic balloon pump insertion [OR 0.63 (0.41–0.99), P = 0.04]. Conclusions Our investigation is the first large US‐wide analysis studying racial variations in TC outcomes. AA overall have more in‐hospital complications; however, the differences are driven by racial disparities in demographics, comorbidities, and socio‐economic factors. |
| format | Article |
| id | doaj-art-3f9a76d95fc148a58462c6b9df00fdce |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2020-06-01 |
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| series | ESC Heart Failure |
| spelling | doaj-art-3f9a76d95fc148a58462c6b9df00fdce2025-02-03T10:25:46ZengWileyESC Heart Failure2055-58222020-06-01731056106310.1002/ehf2.12664Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sampleRaja Zaghlol0Amit K. Dey1Sameer Desale2Ana Barac3Division of Internal Medicine Georgetown University/MedStar Washington Hospital Center Washington DC USASection of Inflammation and Cardiometabolic Diseases National Heart, Lung and Blood Institute Bethesda MD USABiostatistics and Biomedical Informatics Department MedStar Health Research Institute Hyattsville MD USAMedStar Heart and Vascular Institute MedStar Washington Hospital Center 110 Irving Street, NW, Ste 1218 Washington DC USAAbstract Aims Takotsubo cardiomyopathy (TC) is characterized by transient ventricular impairment, often preceded by emotional or physical stress. Racial differences affect the outcomes of several cardiovascular conditions; however, the effect of race on TC remains unknown. This investigation aims to assess the effect of race on in‐hospital outcomes of TC in a large national sample. Methods and results We conducted a US‐wide analysis of TC hospitalizations from 2006 to 2014 by querying the National Inpatient Sample database for the International Classification of Diseases‐ninth Revision TC code, characteristics, and inpatient outcomes. Patients with a primary diagnosis of acute coronary syndrome were excluded to reduce selection bias. Caucasians were compared with African Americans (AA) for differences in baseline characteristics and in‐hospital outcomes. Multivariate regression models were created to adjust for potential confounders. Of 97 650 TC patients, 83 807 (86.9%) were women, 89 624 (91.8%) identified as Caucasians, and 8026 (8.2%) as AA. The annual number of TC hospitalizations increased significantly from 2006 to 2014 in both races (from 335 to 21 265 annual cases, P < 0.001). In‐hospital mortality initially increased (1–2% in 2006 to 5–6% in 2009, P < 0.001) and subsequently remained relatively stable around 5–7% with no significant difference between races. In unadjusted analysis, AA had more cardiac arrests [304 (3.8%) vs. 2569 (2.9%), P = 0.04], invasive mechanical ventilation [1671 (20.8%) vs. 15 897 (17.7%), P = 0.002], tracheostomies [242 (3%) vs. 1600 (1.8%), P = 0.001], acute kidney injuries [1765 (22%) vs. 14 608 (16.3%), P < 0.0001], and longer hospital stays [4.5 (3.2–4.8) vs. 3.8 (3.7–3.9) days, P < 0.0001] compared with Caucasians. After the adjustment for differences in age, gender, comorbidities (using the enhanced Charlson comorbidity index), hospital location/teaching status, and socio‐economic factors, all differences were significantly attenuated or eliminated. Additionally, the adjusted risk was lower in AA compared with Caucasians, for cardiogenic shock [odds ratio (OR) 0.61 (0.47–0.78), P < 0.0001], mechanical ventilation [OR 0.8 (0.70–0.92), P = 0.002] and intraaortic balloon pump insertion [OR 0.63 (0.41–0.99), P = 0.04]. Conclusions Our investigation is the first large US‐wide analysis studying racial variations in TC outcomes. AA overall have more in‐hospital complications; however, the differences are driven by racial disparities in demographics, comorbidities, and socio‐economic factors.https://doi.org/10.1002/ehf2.12664Takotsubo cardiomyopathyStress‐induced cardiomyopathyRaceIn‐hospital outcomes |
| spellingShingle | Raja Zaghlol Amit K. Dey Sameer Desale Ana Barac Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample ESC Heart Failure Takotsubo cardiomyopathy Stress‐induced cardiomyopathy Race In‐hospital outcomes |
| title | Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample |
| title_full | Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample |
| title_fullStr | Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample |
| title_full_unstemmed | Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample |
| title_short | Racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample |
| title_sort | racial differences in takotsubo cardiomyopathy outcomes in a large nationwide sample |
| topic | Takotsubo cardiomyopathy Stress‐induced cardiomyopathy Race In‐hospital outcomes |
| url | https://doi.org/10.1002/ehf2.12664 |
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