TY - JOUR
T1 - Frequency of takotsubo cardiomyopathy in epilepsy-related hospitalizations among adults and its impact on in-hospital outcomes
T2 - A national standpoint
AU - Desai, Rupak
AU - Singh, Sandeep
AU - Patel, Upenkumar
AU - Fong, Hee Kong
AU - Kaur, Vikram Preet
AU - Varma, Yash
AU - Madan, Dyutima
AU - Patel, Smit
AU - Mahuwala, Zabeen
AU - Sachdeva, Rajesh
AU - Kumar, Gautam
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2020/1/15
Y1 - 2020/1/15
N2 - Background: Literature remains constrained to case reports with respect to epilepsy-associated takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy and its impact on in-hospital outcomes remains largely obscure. Methods: The National Inpatient Sample databases (2010–2014) were queried to identify and compare baseline characteristics and outcomes in adult hospitalizations for epilepsy with and without secondary TC using ICD-9-CM codes and propensity-matching. Primary outcomes were the frequency of TC, ensuing all-cause mortality, and complications. Secondary outcome was healthcare resource utilization. Results: Of 981,571 epilepsy-related hospitalizations, 854 (0.1%, 1 in 1000) admissions (unspecified, 49.1%; grand mal/status epilepticus, 28.1% and generalized convulsive 11.7%) revealed associated in-hospital TC. Of the propensity-matched cohorts of epilepsy (TC = 793; mean 61.1 ± 15.0 yrs. & 82.4% females vs. non-TC = 795; mean 60.7 ± 14.2 yrs. & 84.2% females), the TC group consisted more often white (83.7% vs. 78.0%, p < 0.02) patients with higher cardiovascular risk factors. The all-cause inpatient mortality (3.7% vs <11; p = 0.002), arrhythmia (22.7% vs. 18.7%, p = 0.05), cardiac arrest (3.9% vs <11; p = 0.001), cardiogenic shock (3.2% vs <11, p < 0.001), stroke (3.5% vs 1.9%, p = 0.04), venous thromboembolism (4.4% vs. 1.9%, p = 0.004), and respiratory failure (29.4% vs. 14.8%, p < 0.001) were significantly higher in the TC cohort. The mean LOS (6.3 ± 5.6 vs. 5.1 ± 7.1 days), hospital charges ($77,908 vs. $45,881), transfers to other facilities (3.8% vs. 3.2%), and need of home healthcare (19.4% vs. 9.9%) were higher in the TC group (p < 0.001). Conclusion: In this nationwide population-based study, 1 in every 1000 epilepsy-related hospitalizations was associated with secondary TC which resulted in poor inpatient outcomes and higher healthcare resource utilization.
AB - Background: Literature remains constrained to case reports with respect to epilepsy-associated takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy and its impact on in-hospital outcomes remains largely obscure. Methods: The National Inpatient Sample databases (2010–2014) were queried to identify and compare baseline characteristics and outcomes in adult hospitalizations for epilepsy with and without secondary TC using ICD-9-CM codes and propensity-matching. Primary outcomes were the frequency of TC, ensuing all-cause mortality, and complications. Secondary outcome was healthcare resource utilization. Results: Of 981,571 epilepsy-related hospitalizations, 854 (0.1%, 1 in 1000) admissions (unspecified, 49.1%; grand mal/status epilepticus, 28.1% and generalized convulsive 11.7%) revealed associated in-hospital TC. Of the propensity-matched cohorts of epilepsy (TC = 793; mean 61.1 ± 15.0 yrs. & 82.4% females vs. non-TC = 795; mean 60.7 ± 14.2 yrs. & 84.2% females), the TC group consisted more often white (83.7% vs. 78.0%, p < 0.02) patients with higher cardiovascular risk factors. The all-cause inpatient mortality (3.7% vs <11; p = 0.002), arrhythmia (22.7% vs. 18.7%, p = 0.05), cardiac arrest (3.9% vs <11; p = 0.001), cardiogenic shock (3.2% vs <11, p < 0.001), stroke (3.5% vs 1.9%, p = 0.04), venous thromboembolism (4.4% vs. 1.9%, p = 0.004), and respiratory failure (29.4% vs. 14.8%, p < 0.001) were significantly higher in the TC cohort. The mean LOS (6.3 ± 5.6 vs. 5.1 ± 7.1 days), hospital charges ($77,908 vs. $45,881), transfers to other facilities (3.8% vs. 3.2%), and need of home healthcare (19.4% vs. 9.9%) were higher in the TC group (p < 0.001). Conclusion: In this nationwide population-based study, 1 in every 1000 epilepsy-related hospitalizations was associated with secondary TC which resulted in poor inpatient outcomes and higher healthcare resource utilization.
KW - Broken heart syndrome/apical ballooning syndrome
KW - Convulsion
KW - Epilepsy
KW - Seizure
KW - Stress-induced cardiomyopathy
KW - Takotsubo cardiomyopathy
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U2 - 10.1016/j.ijcard.2019.07.034
DO - 10.1016/j.ijcard.2019.07.034
M3 - Article
C2 - 31327513
AN - SCOPUS:85069192375
SN - 0167-5273
VL - 299
SP - 67
EP - 70
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -