Abstract 4134687: Takotsubo Cardiomyopathy Complicating Stroke

Background: There have been studies suggesting Takotsubo cardiomyopathy (TCM) as a potential complication following cerebrovascular accident (CVA), but the association, contributing factors, and prognosis significance have not been well-characterized. Aims: 1) To assess the incidence, factors and prognosis associated with TCM-complicated CVA, and 2) to determine the 30-day unplanned readmission rates for TCM after discharge for CVA and the associated factors. Methods: The U.S. Nationwide Readmission Database was queried using ICD-codes to gather information on discharges with primary diagnosis of CVA between January 2010 and November 2020. Incidence and factors associated with TCM-complicated CVA and 30-day readmissions with primary diagnosis of TCM were assessed. Results: Of 3,696,202 patients hospitalized with primary diagnosis of CVA, 5,526 (0.15%) individuals developed TCM during the admission. Patients with TCM were more likely to be women (80% vs. 52%, P<0.001), present with hemorrhagic (as opposed to ischemic stroke, P<0.001), and have a higher comorbidity burden, adverse events, and longer hospital stay. Mortality rate was significantly higher among those with TCM vs no-TCM (20% vs. 6.4%, P<0.001). Of 3,690,676 patients who were discharged without experiencing TCM during index admission for CVA, 255,947 (6.9%) patients had unplanned readmissions within 30 days of discharge, and 250 (0.1%) of these were with a primary diagnosis of TCM. These individuals with TCM were more likely to be women (78% vs. 51%, P<0.001), had a higher comorbidity burden, and experienced higher mortality rate during readmission compared to those without TCM (12% vs. 5.7%, P=0.009). Conclusions: Although rare, a TCM-complicated CVA can be highly fatal. Female sex, presentation with hemorrhagic stroke and pre-existing health conditions were strong factors associated with TCM-complicated CVA. Readmission for TCM after discharge for CVA is also uncommon but carries a significantly elevated risk of mortality. Our study presents an opportunity to improve processes and clinical outcomes by monitoring and recognizing TCM post-CVA, both during and after hospitalization.