Impact of the COVID-19 Pandemic on Takotsubo Syndrome: Updated Insights from Retrospective Analysis Using the Nationwide Inpatient Sample

Abstract

This study aims to investigate the impact of the COVID-19 pandemic on Takotsubo syndrome (Takotsubo), utilizing data from the National Inpatient Sample (NIS) to analyze trends in prevalence, clinical outcomes, and hospitalization characteristics before and during the pandemic. Our retrospective analysis compares data between 2017-2018 (pre-pandemic) versus 2020-2021 (pandemic), involving over 137 million admissions. Results indicate a significant increase in the prevalence of Takotsubo from 109.07 to 131.19 per 100,000 admissions over 2-year periods. Most Takotsubo patients were elderly females, with a notable rise in associated comorbidities such as hypertension and diabetes during the pandemic. Mortality rates among Takotsubo patients increased during the pandemic with an adjusted odds ratio of 1.28. Notably, Takotsubo patients with COVID-19 infection experienced a higher mortality rate (23.02%) compared to those without (7.61%). Length of hospital stay also increased, particularly for those with COVID-19. Interestingly, the odds of developing Takotsubo were lower in COVID-19 patients compared to non-COVID-19-infected patients, suggesting that pandemic-related stress may affect the broader population more than those directly suffering from the virus. These findings underscore the complex interplay between viral infections, stress, and cardiovascular health, emphasizing the need for integrated care strategies during global health crises.

Introduction

Takotsubo syndrome (Takotsubo), or stress-induced cardiomyopathy, was first reported in 1990 by Sato et al. and is well-recognized for being triggered by both physical and emotional stress [1,2]. This condition has also been reported to be directly related to viral infections such as influenza, parvovirus, and the recent COVID-19 [3-8]. However, the COVID-19 virus brought an unpredictable global health crisis, significantly increasing stress worldwide, which likely had an indirect impact on the prevalence of Takotsubo syndrome. This association presents an exceptional opportunity to examine both the direct and indirect effects of a pandemic-created virus on stress-induced cardiomyopathy, and more broadly, stress-related cardiac incidents. Utilizing the latest data from the National Inpatient Sample (NIS), this study investigates changes in the prevalence, clinical outcomes, and hospital length of stay for patients with Takotsubo during the pandemic, compared to pre-pandemic periods. Moreover, it explores the mortality odds between Takotsubo patients with COVID-19 infection and those without, providing the most updated insights into the intricate dynamics between the viral pandemic and Takotsubo syndrome.

Materials & Methods

Study Design and Data Source

We conducted a retrospective study utilizing the NIS database to investigate the impact of the COVID-19 pandemic on Takotsubo syndrome. The NIS, part of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality, is the largest publicly available all-payer inpatient healthcare database in the United States, covering 97 percent of the population [9]. It provides comprehensive information on inpatient stays, including patient demographics, diagnoses, procedures, and hospital characteristics. The NIS approximates a 20% stratified sample of discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals [10]. We analyzed data from two periods: pre-pandemic (2017-2018) and during the pandemic (2020-2021).

Study Population

The study included all recorded admissions with a diagnosis of Takotsubo syndrome, identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. The dataset included a total of 137,015,481 admissions, with 71,325,934 admissions occurring pre-pandemic (2017-2018) and 65,689,547 during the pandemic (2020-2021). We applied sampling weights provided by the NIS to ensure that the estimates were representative of the national inpatient population.

Variables

Primary Variable: admissions with a diagnosis of Takotsubo syndrome.

Outcome Variables: mortality during hospitalization and length of hospital stay

Covariates:

 - COVID-19 status

 - Demographic factors: age, gender, race, income

 - Comorbidities: hypertension, diabetes, hyperlipidemia, chronic kidney disease, Charlson Comorbidity Index

 - Hospital-related factors: hospital region, bed size, teaching status.

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