Collaborative Research from MedStar Investigators Evaluates Racial Variations in Takotsubo Cardiomyopathy Outcomes

A collaborative team of researchers from across MedStar Health and partners published their work to assess the effect of race on in-hospital outcomes of takotsubo cardiomyopathy (TC) in a large nationwide sample. The team included investigators from MedStar Washington Hospital Center, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Georgetown University, and National Heart, Lung and Blood Institute.

“Racial Differences in Takotsubo Cardiomyopathy Outcomes in a Large Nationwide Sample” was published in ESC Heart Failure. Takotsubo Cardiomyopathy or stress-induced cardiomyopathy is characterized by transient ventricular impairment, often preceded by emotional or physical stressors. Gender, racial, and ethnic differences have been reported with respect to incidence and prognosis of cardiovascular diseases including heart failure and acute myocardial infarction, in part due to variability in genetic, biological and socio-economic factors. Studies have reported increased in-hospital complications in African American patients presenting with TC; however, the effect of race on TC remains unknown

The research included data obtained from the National Inpatient Sample (NIS) database. Of 97, 650 patients included: 83,807 were women; 89, 624 identified as Caucasian; 8,026 identified as African American. Between the two races, demographic characteristics and insurance variables were significantly different.  African American patients were younger, having a higher percentage of men and lower median household income. The rate of TC hospitalizations increased in both races. Mortality rates initially increased from 50 cases (1–2%) to 340 cases (5–6%) and subsequently remained stable around 5–7% with fluctuations but with no overall significant difference between races.  Multivariate regression models were created to adjust for potential confounders.

In unadjusted analysis, African American patients had more cardiac arrests, invasive mechanical ventilation, tracheostomies, acute kidney injuries, and longer hospital stays compared with Caucasians.  After the adjustment for differences in age, gender, comorbidities, hospital location/teaching status, and socio-economic factors, all differences were significantly reduced or eliminated. The adjusted risk was lower in African Americans compared with Caucasians, for cardiogenic shock, mechanical ventilation and intra-aortic balloon pump insertion.

The research concluded that African American patients overall have worse outcomes including longer hospitalizations, higher rates of cardiac arrests, invasive mechanical ventilation, tracheostomies, and acute kidney injury compared with Caucasians. Overall, African American patients have more in-hospital complications; however, the differences are driven by racial disparities in demographics, comorbidities, and socio-economic factors.

The team included Raja Zaghlol,MD; Ana Barac, MD; Amit K. Dey; and Sameer Desale.

ESC Heart Failure, 2020.  DOI: 10.1002/ehf2.12664