Frailty as a predictor of adverse in-hospital outcomes in older patients with Takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TCM), defined by transient left ventricular dysfunction, is commonly triggered by acute emotional/physical stress. It is recognized as a cause of acute coronary syndrome, particularly in the elderly population, as they are vulnerable due to multiple comorbidities, including frailty, a condition marked by reduced functional reserve and increased susceptibility to stressors.

A retrospective analysis of the National Inpatient Sample (2016–2021) was performed to identify patients aged 65 and older hospitalized with TCM using ICD-10-CM codes. Patients were classified based on frailty, defined by Johns Hopkins ACG frailty-defining diagnoses. Multivariable mixed-effects logistic regression was used to identify independent predictors of in-hospital outcomes and compare the groups. Propensity score matching was applied to 736 pairs to control for confounders and assess outcomes.

Frail patients had significantly high in-patient mortality (5.71 vs. 1.09%, P < 0.001), cardiogenic shock (8.47 vs. 4.70%, P = 0.003), sudden cardiac arrest (3.12 vs. 1.49%, P = 0.037), sepsis (2.85 vs. 0.95%, P = 0.008), and major adverse cardiac events (22.55 vs. 18.21%, P = 0.038). There was no significant difference in acute stroke, pulmonary embolism, mechanical circulatory support utilization, cardiac arrhythmias, acute kidney injury, pacemaker insertion, and length of stay between the two groups.

Frailty is associated with an increased in-hospital mortality among elderly patients with TCM. Understanding the importance of frailty in elderly population with TCM helps us in optimizing management strategies and improving patient outcomes.