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.

Frailty is a major determinant of outcomes in patients with coronary artery disease (CAD) undergoing lower limb amputation. This study evaluates the impact of frailty on in-hospital outcomes in these patients.

We performed a retrospective analysis of the National Inpatient Sample (2016–2021) to identify adult patients with CAD who underwent lower limb amputation. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes, and propensity score matching (PSM) was performed to further account for confounding factors.

After PSM, 9,990 patients were included in each cohort. Frail patients experienced higher rates of in-hospital mortality (3.9% vs. 1.5%, P < 0.001), acute limb ischemia (3.8% vs. 3.1%, P = 0.015), fasciotomy (2.1% vs. 1.4%, P < 0.001), stump infection (7.9% vs. 6.6%, P < 0.001), cardiogenic shock (0.9% vs. 0.7%, P = 0.032), sudden cardiac arrest (2.7% vs. 2.1%, P = 0.004), mechanical circulatory support (0.3% vs. 0.2%, P = 0.028), major adverse cardiac and cerebrovascular events (7.7% vs. 5.4%, P < 0.001), and sepsis (18.3% vs. 13.8%, P < 0.001). In multivariable logistic regression analysis, frailty remained an independent predictor of in-hospital mortality and major complications.

Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation. Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.