Clinical Investigation
Congestive Heart Failure
Prevalence of Takotsubo cardiomyopathy in the United States

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Background

The aim of this study was to describe the prevalence of Takotsubo cardiomyopathy (TTC), age-gender interaction, and various comorbidities associated with it based on nationwide hospitalization records. Takotsubo cardiomyopathy is an increasingly reported clinical syndrome; however, there are no data on its prevalence in the general US population.

Methods

The Nationwide Inpatient Sample discharge records were queried for the year 2008 using the International Classification of Diseases, Ninth Revision, code 429.83.

Results

There were 6,837 patients diagnosed with TTC among 33,506,402 hospitalizations in the Nationwide Inpatient Sample database. Women were found to have higher odds of developing TTC (odds ratio 8.8). Women > 55 years old had 4.8 times higher odds for developing TTC when compared with women < 55 years old. Smoking, alcohol abuse, anxiety states, and hyperlipidemia were commonly associated with TTC. The peak incidence of hospitalization for TTC was in summer.

Conclusion

Takotsubo cardiomyopathy was diagnosed in about 0.02% of all hospitalizations in the United States, mostly in elderly women with history of smoking, alcohol abuse, anxiety states, and hyperlipidemia.

Section snippets

Methods

The Nationwide Inpatient Sample (NIS) is the largest all-payer inpatient care database publicly available in the United States. It is an administrative data set created by the Agency for Healthcare Research and Quality from data contributed by participating states.14 During the study years, data derived from up to 8 million hospital stays from about 1,000 hospitals sampled were included. These data approximated a 20% sample of all US community hospitals, defined by the American Hospital

Results

There were 6,837 discharges with the primary diagnosis of TTC in the calendar year 2008. Using the estimated US census in 2008, the overall frequency of TTC was calculated to be 5.2 per 100,000 for women and 0.6 per 100,000 for men. In absolute number of admissions, 6,178 (90.4%) were women, and 660 (9.6%) were men. Most cases were between the age of 66 and 80 years. Whites had a higher frequency of TTC when compared with African Americans and Hispanics. The distribution of TTC was uniform in

Discussion

The main findings of our study are that (1) women > 55 years old have much higher odds of developing TTC; (2) hyperlipidemia, smoking, anxiety states, and alcohol abuse are commonly associated with the diagnosis of TTC; and (3) TTC-related hospitalizations are more common in summer.

Takotsubo cardiomyopathy associated with stress was first described in Japan.1, 16 Stress-induced cardiomyopathy was subsequently reported in non-Asian populations, including the United States5, 17, 18 and Europe.19

Acknowledgements

We appreciate the thoughtful and timely review of Dr Eugene Smith and Dr Rajesh Sachdeva.

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