Murugiah Karthik, Wang Yun, Desai Nihar R, Spatz Erica S, Nuti Sudhakar V, Dreyer Rachel P, Krumholz Harlan M
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JACC Heart Fail. 2016 Mar;4(3):197-205. doi: 10.1016/j.jchf.2015.09.013. Epub 2015 Dec 30.
The aim of this study was to assess trends in hospitalizations and outcomes for Takotsubo cardiomyopathy (TTC).
There is a paucity of nationally representative data on trends in short- and long-term outcomes for patients with TTC.
The authors examined hospitalization rates; in-hospital, 30-day, and 1-year mortality; and all-cause 30-day readmission for Medicare fee-for-service beneficiaries with principal and secondary diagnoses of TTC from 2007 to 2012.
Hospitalizations for principal or secondary diagnosis of TTC increased from 5.7 per 100,000 person-years in 2007 to 17.4 in 2012 (p for trend < 0.001). Patients were predominantly women and of white race. For principal TTC, in-hospital, 30-day, and 1-year mortality was 1.3% (95% confidence interval [CI]: 1.1% to 1.6%), 2.5% (95% CI: 2.2% to 2.8%), and 6.9% (95% CI: 6.4% to 7.5%), and the 30-day readmission rate was 11.6% (95% CI: 10.9% to 12.3%). For secondary TTC, in-hospital, 30-day, and 1-year mortality was 3% (95% CI: 2.7% to 3.3%), 4.7% (95% CI: 4.4% to 5.1%), and 11.4% (95% CI: 10.8% to 11.9%), and the 30-day readmission rate was 15.8% (95% CI: 15.1% to 16.4%). Over time, there was no change in mortality or readmission rate for both cohorts. Patients ≥85 years of age had higher in-hospital, 30-day, and 1-year mortality and 30-day readmission rates. Among patients with principal TTC, male and nonwhite patients had higher 1-year mortality than their counterparts, whereas in those with secondary TTC, mortality was worse at all 3 time points. Nonwhite patients had higher 30-day readmission rates for both cohorts.
Hospitalization rates for TTC are increasing, but short- and long-term outcomes have not changed. At 1 year, 14 in 15 patients with principal TTC and 8 in 9 with secondary TTC are alive. Older, male, and nonwhite patients have worse outcomes.
本研究旨在评估应激性心肌病（TTC）的住院率及预后趋势。
关于TTC患者短期和长期预后趋势，缺乏具有全国代表性的数据。
作者调查了2007年至2012年医疗保险按服务付费受益人中，主要诊断和次要诊断为TTC的住院率、住院期间、30天和1年死亡率以及全因30天再入院率。
主要或次要诊断为TTC的住院率从2007年的每10万人年5.7例增至2012年的17.4例（趋势p<0.001）。患者以女性和白种人为主。对于主要诊断为TTC的患者，住院期间、30天和1年死亡率分别为1.3%（95%置信区间[CI]：1.1%至1.6%）、2.5%（95%CI：2.2%至2.8%）和6.9%（95%CI：6.4%至7.5%），30天再入院率为11.6%（95%CI：10.9%至12.3%）。对于次要诊断为TTC的患者，住院期间、30天和1年死亡率分别为3%（95%CI：2.7%至3.3%）、4.7%（95%CI：4.4%至5.1%）和11.4%（95%CI：10.8%至11.9%），30天再入院率为15.8%（95%CI：15.1%至16.4%）。随着时间推移，两个队列的死亡率和再入院率均无变化。年龄≥85岁的患者住院期间、30天和1年死亡率以及30天再入院率更高。在主要诊断为TTC的患者中，男性和非白种患者的1年死亡率高于相应人群，而在次要诊断为TTC的患者中，在所有3个时间点死亡率都更高。两个队列中，非白种患者的30天再入院率更高。
TTC的住院率在上升，但短期和长期预后未改变。1年后，主要诊断为TTC的患者中15例有14例存活，次要诊断为TTC的患者中9例有8例存活。老年、男性和非白种患者的预后更差。
