title: Trends in hospitalization for takotsubo cardiomyopathy in the United States.
abstract: BACKGROUND
  Takotsubo (or stress induced) cardiomyopathy is characterized by transient left ventricular systolic dysfunction. Recent trends in patient volume, characteristics, and outcomes in the United States are unknown.
  
  
  METHODS
  Using 2007-2012 National Inpatient Sample data, we identified 22,005 adults (≥18 years) with a primary and 31,942 adults with a secondary discharge diagnosis of takotsubo cardiomyopathy (International Classification of Diseases, Ninth Revision, code 429.83) who underwent diagnostic coronary angiography.
  
  
  RESULTS
  During 2007 to 2012, the incidence of takotsubo cardiomyopathy increased over 3-fold: 52/million discharges in 2007 to 178/million in 2012 (P < .001). We found a temporal increase in the prevalence of cardiac arrest, cardiogenic shock, cardiovascular risk factors (diabetes, hypertension), and psychiatric disorders (P trend < .0001 for all). In-hospital mortality was 1.1% and remained unchanged over this period (P = .22). Compared to the primary diagnosis group, mortality in the secondary diagnosis group was higher (1.1% vs 3.2%) and was associated with higher incidence of cardiogenic shock, cardiac arrest, and respiratory failure. Men represent 8% of patients in the primary diagnosis group and 12% in the secondary group. In both groups, men had a higher incidence of shock, cardiac arrest, and respiratory failure. Although their mortality was higher than women in the primary group (3.0% vs 0.9%, adjusted odds ratio 3.85, 1.74-8.51), it was comparable in the secondary group (4.8% vs 3.0%).
  
  
  CONCLUSIONS
  We found a marked increase in the hospitalization for takotsubo cardiomyopathy in the United States in recent years, suggesting higher incidence than prior reports. Although outcomes have remained favorable, there is an increasing burden of cardiovascular and psychiatric disorders in this population with growing cost of care. Risk of mortality is higher in men and in patients with underlying critical illness. The excess mortality in these groups appears to be mediated by greater severity of disease.
authors: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: rohan-khera@uiowa.edu.
authors: Rohan
authors: R
authors: Khera
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors: KellyAnn
authors: K
authors: Light-McGroary
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors: Firas
authors: F
authors: Zahr
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors: Phillip A
authors: PA
authors: Horwitz
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Institute of Clinical and Translational Science (ICTS), University of Iowa Carver College of Medicine, Iowa City, IA.
authors: Saket
authors: S
authors: Girotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D054549:Takotsubo Cardiomyopathy / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult